Now, back to the ultrasensitive PSA and not wanting to wait 3 more months. I’ve done a lot of reading – more than a dozen books, a lot of studies, and been to a conference – on prostate cancer. All since January 2011. For me, knowledge is power, or at least the illusion of control. Illusion being the operative word, perhaps.
Either way, I’m not one to sit back and wait, I like to be proactive. This article on ultrasensitive PSAs (at NYUMC.org) is about a study using ultrasensitive PSA to predict the risk of early biochemical relapse – which means that it could be returning. In short, the lower the ultrasensitive PSA at the nadir (lowest point) after radical prostatectomy, the better. Now the patients in this study were from the time period January 1997 to December 2000 so treatments are BETTER now and detection is better. Relapse statistics should be lower across all the groups now, but the relative numbers will likely still hold so I wanted to know the ultrasensistive PSA numbers and to track them.
That said, the results from that study say: “At a mean followup of 3.1 years 54 of 545 men (9.9%) [remember this was from 1997-2000 so this percentage would likely be lower now] experienced biochemical relapse with a mean time to relapse of 25.2 months [PSAs were rising above a certain level]. Relapse rates in men with a PSA nadir of less than 0.01 (423 [men in that group]), 0.01 (75), 0.02 (19) and 0.04 or greater ng/ml (28) were 4%, 12%, 16% and 89%, respectively. Men with a nadir of less than 0.01 ng/ml had a significantly lower relapse rate than men with a nadir of 0.01 (p 0.01), 0.02 (p 0.025) or 0.04 or greater ng/ml (p 0.01).” In other words, the lower the lowest point of the PSA, the lower the chance of biochemical relapse. So, it seems important to know the value. And for me, I’d rather know sooner versus later.
So, I’d done some reading about following the PSA post-surgery and many Doctors recommend doing so somewhere around 3 months after surgery. Given the half-life of PSA in the body is between 2.5 and 3.5 days, I realized that at about 5 and a half weeks, I would have had at least around 10 “half-lives” pass if the half-life in my body was 3.5 days. If it had been in the 2.5 day range, the number of “half-lives” that had passed would have been higher, around 15. So at 5.5 weeks, the PSA should be at most 1/2048th of the maximum value on the day of the surgery. Pre-surgery it had been 3.3 which would have put it at 3.3/2048 which would have put it at 0.001. Of course, if the prostate had been squeezed like a lemon in a juicer or for some reason had released excess PSA during surgery, it could have been higher. But even IF the PSA had been 33.3 because of all the surgical trauma, it should have been down to at least 0.01 based on the low value of PSA half-lives.
Not being one to wait and wait, particularly until July, I went to LabsMD.com (there are other similar sites) and did a search for PSA and ordered the ultrasensitive PSA. I picked one of the close LabCorp offices and went over and had them take the blood. The next morning by 9:45AM east coast time I had the results and they showed “<0.01” which is the lowest value you can have on the LabCorp tests. Another good result and big relief. Stress from PSA values is what they call PSA anxiety, and everyone can see why.
By the way, I had ordered a PSA test (free PSA and regular PSA) from them after I got the first elevated test back in December because Mayo did not track the free PSA. The regular PSA had tracked the Mayo number and the free PSA had shown a higher probability of PCa.
This was a great relief and I didn’t have to wait until July. The test was a few dollars under $90, but was well worth it for the peace of mind and, most importantly, it will allow me to track it whenever I want. The thing I had to remember was that having the test 5.5 weeks after surgery could have been a bit soon so, if it had been at all elevated, there would have been a reason. From what I’ve read they usually wait at least 6-8 weeks after surgery and often 12.
For me, being proactive and doing it earlier than they were doing gives another data point and luckily peace of mind. It also gives a long-term data trail so that over years or decades you can have a lot of information instead of just something like “less than 0.1”.
By the way, I considered doing one the day after I got home from the hospital in order to see what the number was just days after surgery and see what it should be coming down from. I couldn’t work up the energy to do so at the time, so did not do so. Now, I wish I had just for the knowledge.
Here are a few links dealing with the ultra-sensitive PSA test and why it is important after having treatment: