Hi Mike, - Let me respond to the questions that you have posed and to which the answers, in my opinion, have been confusing, to say the least.
For years, the Clinical Standard for "undetectable PSA" in routine monitoring situations following surgery has been LESS THAN 0.1 ng/ml, which is usually depicted as < 0.1 on Laboratory Reports. Although there are RARE individual situations where this may not be the standard used by an individual Physician, it remains the most widely accepted definition of "undetectable PSA', BY FAR.
So, in nearly every case of ROUTINE monitoring following surgery this still remains the criteria for the use of the term, "undetectable" in reference to post-treatment PSA. The figures you cite in your Posts are all below this Standard if the decimal points are accurately reflected.
Obviously, accuracy of the decimal point placement is critically important in judging PSA significance in the post-treatment monitoring, as is the understanding of the metric system in use. The 0.1 ng/ml threshold, referred to above, represents 1/10th of a BILLIONTH of a Gram of PSA found in 1 milliliter of blood. The finding of 0.01 ng/l is 1/100th and 0.001 is 1/1000th of a BILLIONTH of a gram, so these are "minute" (my-noot) amounts of PSA that are present.
Again, anything below 0.1 ng/ml (<0.1) is therefore considered clinically undetectable in routine monitoring of low and/or moderate risk, post-treatment results.
The < icon always identifies the term "LESS THAN" and reflects the fact that any PSA present, IF ANY, is BELOW the known reliability of the assays (the test's) known sensitivity and so is reported thusly.
As long as PSA results remain below the 0.1 ng/ml level, you usually need not initiate any aggressive secondary treatment, in low or moderate risk patients. I hope this helps your understanding. - John@newPCa.org (aka) az4peaks
Hi Tim, - Having a world renowned expert like Jonathan Epstein at Johns Hopkins (JH) review the Biopsy slides is an excellent choice. I would suggest that you call Johns Hopkins and tell them your Dad's situation and ask for information about international shipping of the slides and appropriate preparation instructions.
Go here for information about the JH Department of Urologic Pathology with several "contact" phone numbers and addresses.
Hi rib, - It certainly is reassuring that your Biopsy was negative for Prostate Cancer (PCa). Unfortunately, traditional patterned but "random" Prostate Biopsies cannot totally rule out PCa as they find only about 80% of existing PCa cases on an initial attempt.
"Standard" needle biopsies of the Prostate, today, take about 12 tissue samples in a random, but patterned, manor with any additional samples representing either "suspicious" areas seen on the UltraSound images used to guide the Biopsy device location or compensation for an unusually large volumed Prostate gland.
Since the SAMPLES are exactly what they are called, "samples" they do not NECESSARILY represent a totally accurate reflection of the either the amount or the aggressiveness of the Cancer tumor(s) present in the TOTAL prostate. They do, however, (4 out of 5 times) reliably establish the PRESENCE of PCa, if it exists. A subsequent second Biopsy rounds these "positive" (PCa identified) findings to about 90% of existing cases eventually found. The remaining 10% take 3 or more Biopsies to be eventually identified.
Some reasonable assumptions can be made after two or more serial Biopsies are found to be negative (no PCa identified) and to a lesser extent even after an initial negative biopsy. These are (1) that any PCa that might have been missed, is not likely to constitute a widely spread PCa volume within the Prostate itself. (2) Due to #1, it is substantially less likely to presently constitute an advanced PCa, thus increasing the chances of successful treatment and "cure".
However these are assumptions and NOT GUARANTEES, so follow-up monitoring and other possible diagnostic endeavors may be employed to further enhance such findings. Therefore, it should be recognized that "positive" Biopsy results alone are much more "certain" as to the presence of PCa, than "negative" findings are indicative as to its non-existence.
There are other causes for elevated PSA readings, if that was the sole cause for your Biopsy, particularly Prostatitis (Infammation) and/or BPH (Benign Prostate Hyperplasia (or Hypertrophy) so PCa may not be the cause of your elevated PSA. Follow-up may be able to better identify the most likely cause. That will be the most beneficial time to determine your next step in action.
If the decision is to take conservative monitoring action, you should have a formal plan to regularly evaluate diagnostic results and act accordingly to what they tell you is appropriate at the time. I would strongly suggest that you acquire copies of your diagnostic results, for your records, including PSA results and your Biopsy Pathology Report, for future comparison of results and clarification of possible causes.
History: Originally, there was considerable controversy as to whether exposure to Agent Orange resulted in an increased risk of numerous Cancers, including of course, Prostate Cancer (PCa).
Vietnam veterans were now composing a substantial portion of the age-related segments of the general population that were subject to naturally acquiring PCa. Along with very "mixed", and often conflicting Study results, there was no clear-cut answer to the question. Additionally, if it was thought to be a cause, how would it be determined which individual service men were actually physically exposed to Agent Orange during their active duty?
Finally, the controversy was pragmatically resolved by a VA declaration, that it would be ASSUMED that all service men,many years later acquiring PCa, whose records could establish that they had physically served in the Vietnam war theater, would be PRESUMED to have had Agent Orange exposure that caused their PCa.
Realistically, this was a "politically correct" decision, more than one clearly supported by scientific evidence, but due to the factors stated above, it appeared to the decision-makers that this was the most practical and expedient solution to a growing controversial issue, as the men effected continued to age.
As a result, a geographical "war zone" area (and time-frame) was established, that constituted the service area in which one had to have served for AUTOMATIC approval as "cause and effect" of their later PCa diagnosis.
Because of the volume of the such applications, it can take a while for such applications to be finally approved, but it is the qualification of time and location of service that is being checked and not any actual exposure to presumed cancer causing agents that is involved. Approval normally starts at 100% disability and is re-evaluated later, following treatment for any residual morbidity and is usually permanently adjusted downward, unless diagnosed with very advanced disease.
Once approved, reimbursement is paid retroactive to the date of application, so a potential beneficiary needs to be patient, since delays are common. Hope this history helps understand the procedure. - John@newPCa.org (aka) az4peaksView Thread
HFsbertram, - More information is needed to intelligently reply regarding your Father's specific case, but these realistic "in general" considerations may be sufficient to remove some of the present confusion in your mind
First, there are no absolutely right or wrong answers to your fathers dilemma, since recognized experts disagree on the best way to treat Prostate Cancer (PCa) at various stages of the disease.
Second, your Father's age, is a major consideration when weighing viable treatment options, since the average life expectancy for an 80 year old male, according to Social Security Life Actuarial Tables, is 7.9 years.
Third, statistically, most men diagnosed at the age of 80 are more likely to die of something other than PCa, since it is often, but not always, a slower growing tumor than many other competing threats to survival at more advanced ages.
Fourth, co-morbidity (other diseases and symptoms that may simultaneously exist) are to be considered when weighing advantages and disadvantages of varying treatment options.
Fifth, one of the most important considerations is the clinical Gleason SCORE which helps to determine the likely aggressiveness of the current disease. The effectiveness of specific treatments in "curing" or "controlling" the present disease is highly dependent on whether the STAGE of present disease is thought to be "localized", "locally extended, which is sometimes called regional" or whether it is already "systemic" and is circulating in the blood system.
Unfortunately, some of these factors cannot usually be determined with certainty and the statistical likelihoods (the odds) must be used to predict most likely probabilities.
Sixth, you are already, there is a great deal of misinformation in the public sources (like the Internet), as well as its ability to provide many very good resources. The problem is that the newly diagnosed have little background or scientific knowledge to judge which is reliably accurate and which is NOT.
The fact is that the the strength of the photon rays and the proton rays used in the two forms of Radiation Therapy (RT) are determined, planned and controlled by the those professionals rendering the treatment. At the same level of measurement arriving at the targeted area, the rays themselves, are equally strong and effective at that point of delivery. There are other differences in delivery but NOT in the presently PROVEN or KNOWN effectiveness in Cancer Control.
I am NOT a physician but If you will E-mail me, I will furnish you with my medical background and my telephone number in Scottsdale, AZ if you wish. - John@newPCa.org (aka) az4peaksView Thread
Hi, - According to the numbers that you quote in your Post, your Husband has relatively aggressive form of Prostate Cancer (PCa) and should be weighing his treatment options. Most experts would agree that a Gleason Score of (4 4)=8 suggests a "high risk" malignancy, which is likely to progress unless intervention is made.
Which of the treatment options he wishes to pursue is subject to the review of the complete findings shown in the Pathology Report from his Biopsy. Depending on the source of that original Pathology Report, you may wish to have the Biopsy slides reviewed by a recognized expert in the examination of Prostate tissue.
There are several, usually found at major University teaching institutions and/or the recognized 'Centers of Excellence". Dr. Epstein at Johns Hopkins and Dr. Bostwick at Bostwick Laboratories are two Pathologists that immediately come to mind.
Good luck and become educated about the disease, so that you can make INFORMED decisions. - John@newPCa.org (aka) az4peaksView Thread
Hi miguelito, - There really is no such thing as A detectable PSA of "0" in PSA readings, although the term "zero" is often carelessly used when reporting such results.
PSA results are always limited by the reliability threshold of the assay (test) material used to measure its presence in the bloodstream. Such threshold limitations vary, due to the KNOWN sensitivity level of the manufacturer's specific assay material used. So, TECHNICALLY, there cannot be such thing as a biological "0" result.
Depending on the tests known sensitivity level, results that are below reliable ng/ml level (0.1, 0.01 or 0.001 as examples) are clearly identified by placing a "LESS THAN" icon designation (<), immediately preceding the stated numerical result. EXAMPLE: <0.1 ng/ml means that any reading obtained was either below the tests reliability level.
Therefore, when the term "zero" is used, it refers to the "clinical" definition of the term, which is USUALLY any finding below 0.1 ng/ml on the Standard PSA test,. Unfortunately, in some verbal communication the "LESS THAN' designation (<) is sometimes missed or ignored by the communicator, which erroneously distorts its meaning and significance.
This is why it is always recommended that patients obtain a printed copy of such laboratory results, for their records. - John@newPCa.org (aka) az4peaksView Thread
Hi Woodworking, - Without more information, like a PSA post treatment listing of all dates and readings I can't directly comment on your specific situation.
In GENERAL, however, confirmed PSA readings that exceed 0.1 to 0.2 ng/ml are highly suspicious of a recurrence, which is further supported if 3 consecutive PSA results (preferably from the same Lab) indicate a rising trend.
Continued monitoring at 3 to 6 month intervals are often suggested to establish such trends. If a recurrence appears after 2 to 3 years following surgery, it may be a recurrence that is "localized" and could POSSIBLY be successfully treated with Salvage Radiation Therapy (SRT) but this needs to be determined by professional advisors. The post surgical Pathology Report may hold important information that should be reviewed.
Hormone Therapy (HT) is not usually a curative solution and does depress actual PSA readings, making monitoring to determine recurrence more difficult and unreliable.
Good luck and don't hesitate to consider a second opinion on what appropriate action should be taken. I am not a Physician! - John@newPCa.org (aka) az4peaksView Thread
Hi Jim_T, - Technically, a surgically treated Prostate Cancer (PCa) patient is considered Cancer-free as long as his PSA remains "clinically" undetectable, which is any reading LESS THAN 0.1 ng/ml (<0.1).
Statistically, about 50% of all recurrences occur within the first 2 to 3 years following surgery. After 5 years of survival, about 90% of eventual recurrences have already occurred. By 10 years, the likelihood of recurrence is so small (far less than 1%) that it does not impact a straight horizontal line on a graph.
I hope this helps! - John@newPCa.org (aka) az4peaksView Thread
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