PSA sensitivity query

[MZB]

I often read that folks have a PSA of <.1, which is good.
Mine is 0.01 (< .01 would be termed undetectable).

Does this mean the first type is the "regular" PSA test and mine is the
ultra sensitive PSA test?

But don't they have readings of 3 decimal points?

Is that a super-sensitive PSA test?

I guess I am getting confused with the terminology

Mel

[Heather]

I believe the standard garden variety test can only go as low as 0.05, so
yours would be the super sensitive test.

Hey, it is an amazing number you have.......stop worrying!! If it goes up
to 5.0 or more, then you have a reason to worry........okay??

Relax........Heather

"MZB" <[email protected]> wrote in message
news:hnj6q8$ng1$[email protected]..
>I often read that folks have a PSA of <.1, which is good.
> Mine is 0.01 (< .01 would be termed undetectable).
>
> Does this mean the first type is the "regular" PSA test and mine is the
> ultra sensitive PSA test?
>
> But don't they have readings of 3 decimal points?
>
> Is that a super-sensitive PSA test?
>
> I guess I am getting confused with the terminology
>
> Mel
>

[safire]

On 3/14/2010 7:32 PM, Ignorant Heather wrote:

> "MZB"<[email protected]> wrote in message
> news:hnj6q8$ng1$[email protected]..
>> I often read that folks have a PSA of<.1, which is good.
>> Mine is 0.01 (< .01 would be termed undetectable).
>>
>> Does this mean the first type is the "regular" PSA test and mine is the
>> ultra sensitive PSA test?
>>
>> But don't they have readings of 3 decimal points?
>>
>> Is that a super-sensitive PSA test?
>>
>> I guess I am getting confused with the terminology
>>
>> Mel
>>
> I believe the standard garden variety test can only go as low as 0.05, so
> yours would be the super sensitive test.
>
> Hey, it is an amazing number you have.......stop worrying!! If it goes up
> to 5.0 or more, then you have a reason to worry........okay??

No not OK. In fact, stupid.

"For Chan, and the scientists and physicians at Hopkins, the number to
take seriously is 0.2 nanograms/milliliter. ''That's something we call
biochemical recurrence. But even this doesn't mean that a man has
symptoms yet. People need to understand that it might take months or
even years before there is any clinical physical evidence."

>

>

>
>

[Heather]

Piss off, cretin!!

Btw......have you ever had PCa or do you just like to (s)troll in and harass
people who don't really give one sweet damn about you!! Back in the box
with you......

"safire" <[email protected]> wrote in message
news:hnjamo$sel$[email protected]..
> On 3/14/2010 7:32 PM, the uber-intelligent Heather wrote:
>
>> I believe the standard garden variety test can only go as low as 0.05, so
>> yours would be the super sensitive test.
>
> No not OK. In fact, stupid.
>
> "For Chan, and the scientists and physicians at Hopkins, the number to
> take seriously is 0.2 nanograms/milliliter. ''That's something we call
> biochemical recurrence. But even this doesn't mean that a man has symptoms
> yet. People need to understand that it might take months or even years
> before there is any clinical physical evidence."
>
>>
>
>>
>
>>
>>
>

[Steve Kramer]

"MZB" <[email protected]> wrote in message
news:hnj6q8$ng1$[email protected]..
>I often read that folks have a PSA of <.1, which is good.
> Mine is 0.01 (< .01 would be termed undetectable).
>
> Does this mean the first type is the "regular" PSA test and mine is the
> ultra sensitive PSA test?
>
> But don't they have readings of 3 decimal points?
>
> Is that a super-sensitive PSA test?
>
> I guess I am getting confused with the terminology

-- skramer remarks

The last I heard there are at least 26 assays now. It is probably
sufficient to know that some test to one-tenth of a nanogram; some test to
two digits past the decimal; and some test to three digits past the decimal.
When you are looking at three digits past the decimal, you are talking
thousands of a nanogram. Example: .001 PSA would be 1,000,000,000,000th of
a gram.


PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 10/10/10
Illegitimati non carborundum

[Steve Kramer]

"Heather" <[email protected]> wrote in message
news:hnja36$m8o$[email protected]..
>I believe the standard garden variety test can only go as low as 0.05, so
>yours would be the super sensitive test.
>
> Hey, it is an amazing number you have.......stop worrying!! If it goes up
> to 5.0 or more, then you have a reason to worry........okay??

-- skramer remarks

Actually, he's coming off surgery. So, he pretty much should start worrying
at 0.2, or less if he discerns a trend over 0.1. After successive PSAs of
..27 and .37, my doc scheduled SRT.

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 10/10/10
Illegitimati non carborundum

[MZB]

Thanks Steve.
Geeezzzzz, I never said I was worrying. We all worry about the other shoe to
drop with this f-disease.

But, frankly, I was merely asking a simple question.

Let me rephrase: what does ultra-sensitive mean? What does super-sensitive
mean?

Maybe there is no clearcut definition.

Heather-- I've been told that 0.20 is the major cutoff point. That's when
(if confirmed by a 4-week follow-up PSA) I have to seriously consider doing
salvage radiation, and best to do it quickly. I was also told that if it is
0.1 I should repeat the test in 4 weeks as we need to stay on top of things
(I have a G 4+3 with one focally positive margin of < 0.5 mm). From my
reading, one has a better chance of a cure if one does salvage radiation
before the PSA gets to 0.5.

Mel

Mel


"Steve Kramer" <[email protected]> wrote in message
news:hnjidh$hpe$[email protected]..
> "MZB" <[email protected]> wrote in message
> news:hnj6q8$ng1$[email protected]..
>>I often read that folks have a PSA of <.1, which is good.
>> Mine is 0.01 (< .01 would be termed undetectable).
>>
>> Does this mean the first type is the "regular" PSA test and mine is the
>> ultra sensitive PSA test?
>>
>> But don't they have readings of 3 decimal points?
>>
>> Is that a super-sensitive PSA test?
>>
>> I guess I am getting confused with the terminology
>
> -- skramer remarks
>
> The last I heard there are at least 26 assays now. It is probably
> sufficient to know that some test to one-tenth of a nanogram; some test to
> two digits past the decimal; and some test to three digits past the
> decimal. When you are looking at three digits past the decimal, you are
> talking thousands of a nanogram. Example: .001 PSA would be
> 1,000,000,000,000th of a gram.
>
>
> PSA 16 10/17/2000 @ 46
> Biopsy 11/01/2000 G7 (3+4), T2c
> RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
> PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
> EBRT 05-07/2002 @ 47
> PSA .34 .22 .15 .21 .32 PSAD 0.56 years
> Lupron 07/03 (1 mo) 8/03 and every 4 months there after
> PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
> Casodex added daily 07/06
> PSA undetectable since. Next Assay 10/10/10
> Illegitimati non carborundum
>

[Heather]

"MZB" <[email protected]> wrote in message
news:hnjlv4$bf5$[email protected]..
>
> Heather-- I've been told that 0.20 is the major cutoff point. That's when
> (if confirmed by a 4-week follow-up PSA) I have to seriously consider
> doing salvage radiation, and best to do it quickly. I was also told that
> if it is 0.1 I should repeat the test in 4 weeks as we need to stay on top
> of things (I have a G 4+3 with one focally positive margin of < 0.5 mm).
> From my reading, one has a better chance of a cure if one does salvage
> radiation before the PSA gets to 0.5.
>
> Mel
>
Thanks Mel.......my husband's category is totally different than yours and
as he never had surgery, I goofed. Thanks to Steve for setting that
straight. FWIW, Ron had 2 types of radiation and then HT.

Heather

[Steve Kramer]

"MZB" <[email protected]> wrote in message
news:hnjlv4$bf5$[email protected]..

> Thanks Steve.
> Geeezzzzz, I never said I was worrying.

Nor did I get that impression. I was strying to put a point to the
differences in assays. I have often opined herein that the ultra sensitive
tests, while an scientific marval, are almost useless.


> Let me rephrase: what does ultra-sensitive mean? What does super-sensitive
> mean?

I think (but based only on listening to folks here);

standard tests to 0.1
super sensitive tests to 0.01 to 0.05
ultra sensitive tests to 0.002 to 0.003

[ron]

On Mar 14, 11:36*am, "MZB" <m...@noway.prudigy.net> wrote:
> I often read that folks have a PSA of <.1, which is good.
> Mine is 0.01 (< .01 would be termed undetectable).
>
> Does this mean the first type is the "regular" PSA test and mine is the
> ultra sensitive PSA test?
>
> But don't they have readings of 3 decimal points?
>
> Is that a super-sensitive PSA test?
>
> I guess I am getting confused with the terminology
>
> Mel

Hi Mel...Just to be clear, you are asking about the total PSA test, as
opposed to the free PSA test. There are two types of total PSA test,
standard and ultrasensitive. A number of different companies produce
their own version of these tests. Generally, the standard test is
accurate enough to detect 0.1 ng/ml of PSA with +/- 10% accuracy under
controlled laboratory conditions. So even though the standard test
could differentiate between 0.1 and 0.09 ng/ml, most labs just report
anything below 0.1 as <0.1. Most ultrasensitive tests read accurately
to three decimal places (0.001). Most labs only report the result to
two decimal places with a lower limit of <0.01 ng/ml, however some
labs do report all three decimal places.

Things can get confusing. For example, Hybritech's standard PSA test
is actually accurate down to 0.02 ng/ml. If you ask for the standard
test and your hospital uses the Hybritech assay or sends out to
Hybritech, Hybritech runs their assay and reports results with a lower
limit of <0.1. If you ask for the Hybritech ultrasensitive test, the
same exact assay is performed but now the results are reported back
with a lower detection limit of <0.02 ng/ml. The only difference is
the lab code!

As to the future, well here is an interesting reference...ron

Proc Natl Acad Sci U S A. 2009 Nov 3;106(44):18437-42; Nanoparticle-
based bio-barcode assay redefines "undetectable" PSA and biochemical
recurrence after radical prostatectomy; Thaxton CS, Elghanian R,
Thomas AD, Stoeva SI, Lee JS, Smith ND, Schaeffer AJ, Klocker H,
Horninger W, Bartsch G, Mirkin CA.

We report the development of a previously undescribed gold
nanoparticle bio-barcode assay probe for the detection of prostate
specific antigen (PSA) at 330 fg/mL, automation of the assay, and the
results of a clinical pilot study designed to assess the ability of
the assay to detect PSA in the serum of 18 men who have undergone
radical prostatectomy for prostate cancer. Due to a lack of
sensitivity, available PSA immunoassays are often not capable of
detecting PSA in the serum of men after radical prostatectomy. This
new bio-barcode PSA assay is approximately 300 times more sensitive
than commercial immunoassays. Significantly, with the barcode assay,
every patient in this cohort had a measurable serum PSA level after
radical prostatectomy. Patients were separated into categories based
on PSA levels as a function of time. One group of patients showed low
levels of PSA with no significant increase with time and did not
recur. Others showed, at some point postprostatectomy, rising PSA
levels. The majority recurred. Therefore, this new ultrasensitive
assay points to significant possible outcomes: (i) The ability to tell
patients, who have undetectable PSA levels with conventional assays,
but detectable and nonrising levels with the barcode assay, that their
cancer will not recur. (ii) The ability to assign recurrence earlier
because of the ability to measure increasing levels of PSA before
conventional tools can make such assignments. (iii) The ability to use
PSA levels that are not detectable with conventional assays to follow
the response of patients to adjuvant or salvage therapies.

PMID: 19841273

[MZB]

Ron:

That's interesting. So I should assume that my reading of exactly .01 is
really a round-off of the ultrasensitive test? I know from friends that the
lowest report from this lab is <.01. So my .01 could be as high as .014? But
could it be as low as .005? Would that be listed as .01 and anything less
than that reported as <.01?

Just curious.

Mel


"ron" <[email protected]> wrote in message
news:[email protected]...
On Mar 14, 11:36 am, "MZB" <m...@noway.prudigy.net> wrote:
> I often read that folks have a PSA of <.1, which is good.
> Mine is 0.01 (< .01 would be termed undetectable).
>
> Does this mean the first type is the "regular" PSA test and mine is the
> ultra sensitive PSA test?
>
> But don't they have readings of 3 decimal points?
>
> Is that a super-sensitive PSA test?
>
> I guess I am getting confused with the terminology
>
> Mel

Hi Mel...Just to be clear, you are asking about the total PSA test, as
opposed to the free PSA test. There are two types of total PSA test,
standard and ultrasensitive. A number of different companies produce
their own version of these tests. Generally, the standard test is
accurate enough to detect 0.1 ng/ml of PSA with +/- 10% accuracy under
controlled laboratory conditions. So even though the standard test
could differentiate between 0.1 and 0.09 ng/ml, most labs just report
anything below 0.1 as <0.1. Most ultrasensitive tests read accurately
to three decimal places (0.001). Most labs only report the result to
two decimal places with a lower limit of <0.01 ng/ml, however some
labs do report all three decimal places.

Things can get confusing. For example, Hybritech's standard PSA test
is actually accurate down to 0.02 ng/ml. If you ask for the standard
test and your hospital uses the Hybritech assay or sends out to
Hybritech, Hybritech runs their assay and reports results with a lower
limit of <0.1. If you ask for the Hybritech ultrasensitive test, the
same exact assay is performed but now the results are reported back
with a lower detection limit of <0.02 ng/ml. The only difference is
the lab code!

As to the future, well here is an interesting reference...ron

Proc Natl Acad Sci U S A. 2009 Nov 3;106(44):18437-42; Nanoparticle-
based bio-barcode assay redefines "undetectable" PSA and biochemical
recurrence after radical prostatectomy; Thaxton CS, Elghanian R,
Thomas AD, Stoeva SI, Lee JS, Smith ND, Schaeffer AJ, Klocker H,
Horninger W, Bartsch G, Mirkin CA.

We report the development of a previously undescribed gold
nanoparticle bio-barcode assay probe for the detection of prostate
specific antigen (PSA) at 330 fg/mL, automation of the assay, and the
results of a clinical pilot study designed to assess the ability of
the assay to detect PSA in the serum of 18 men who have undergone
radical prostatectomy for prostate cancer. Due to a lack of
sensitivity, available PSA immunoassays are often not capable of
detecting PSA in the serum of men after radical prostatectomy. This
new bio-barcode PSA assay is approximately 300 times more sensitive
than commercial immunoassays. Significantly, with the barcode assay,
every patient in this cohort had a measurable serum PSA level after
radical prostatectomy. Patients were separated into categories based
on PSA levels as a function of time. One group of patients showed low
levels of PSA with no significant increase with time and did not
recur. Others showed, at some point postprostatectomy, rising PSA
levels. The majority recurred. Therefore, this new ultrasensitive
assay points to significant possible outcomes: (i) The ability to tell
patients, who have undetectable PSA levels with conventional assays,
but detectable and nonrising levels with the barcode assay, that their
cancer will not recur. (ii) The ability to assign recurrence earlier
because of the ability to measure increasing levels of PSA before
conventional tools can make such assignments. (iii) The ability to use
PSA levels that are not detectable with conventional assays to follow
the response of patients to adjuvant or salvage therapies.

PMID: 19841273

[ron]

Hi Mel...See my comments within your post...ron

On Mar 15, 11:25*am, "MZB" <m...@noway.prudigy.net> wrote:
> Ron:
>
> That's interesting. So I should assume that my reading of *exactly .01 is
> really a round-off of the ultrasensitive test?

Yes

> I know from friends that the
> lowest report from this lab is <.01. So my .01 could be as high as .014?

Yes

> But could it be as low as .005?

That's a good question Mel. I have assumed that for labs performing
the ultrasensitive test and then reporting the result back to 2
decimal places lower limit results are not rounded, but rather cut
off; anything less than 0.01, for example 0.001 or 0.009, would be
reported back as <0.01. You could contact the company that
manufactures the analysis used to produce your test result (Lab Corp,
Quest Diagnostics, etc.) and ask that question (are lower limit
results rounded or clipped). If you do, I'd be curious what you
learn.

> Would that be listed as .01 and anything less than that reported as <.01?

> Just curious.
>
> Mel

[prostwell]

Hi MZB, Steve,

Interesting thread

I just had my third post RLRP PSA test at <.1 on Feb 26.

> *After successive PSAs of
> .27 and .37, my doc scheduled SRT.

Did you use the standard test?
I am pondering if I should be using a more sensitive test.
(My PCP and URO both say this is unnecessary.)
But in your case, it seemed to have been useful to establish a
doubling time, no?

[Steve Kramer]

"prostwell" <[email protected]> wrote in message
news:[email protected]..
Hi MZB, Steve,

Interesting thread

I just had my third post RLRP PSA test at <.1 on Feb 26.

> After successive PSAs of
> .27 and .37, my doc scheduled SRT.

Did you use the standard test?
I am pondering if I should be using a more sensitive test.
(My PCP and URO both say this is unnecessary.)
But in your case, it seemed to have been useful to establish a
doubling time, no?

==> No uro or onc that I know of (based on my readings) acts upon
post-operative assay results when they are less than 0.10. I don't think I
have seen any one of them act on PSAs of less than 0.20. In my case, we
acted when my PSA rost to 0.37 and that was considered "aggressive treatment
for aggressive cancer."

==> There are those here, and I have no argument with them, who want to
know their full history, hoping to understand that aggressiveness of the
cancer, even if they will not treat the disease until the number surpasses
0.20, 0.30, 0.50, or even 1.00. My personal opinion is that the value of
knowing is trumped by the uneccesary angst that is almost always going to
attend that knowledge.



--
skramer remarks
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 10/10/10
Illegitimati non carborundum

[starrin]

On Mon, 15 Mar 2010 13:25:46 -0400, "MZB" <[email protected]>
wrote:
>That's interesting. So I should assume that my reading of exactly .01 is
>really a round-off of the ultrasensitive test? I know from friends that the
>lowest report from this lab is <.01. So my .01 could be as high as .014? But
>could it be as low as .005? Would that be listed as .01 and anything less
>than that reported as <.01?

Of interest, my lab reports my PSA as <0.014, which is as low as they
go