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User

Posted 08 Jun 2018 at 09:06

Ah I can empathise with your worries! I think you should get that retest before your appointment.

Unfortunately you are probably in a grey area regarding salvage treatment, this is because the current guidelines talk about recurrence at 0.2 but there is a body of evidence that supports earlier intervention as soon as there is a clear rising trend, my onco said they wouldn't do anything until it got to 0.1 fortunately my last test went down.

So I would at least get a second opinion from an oncologist and research salvage radio therapy on this site and others so you can make an informed choice about what to do next.

User

Posted 08 Jun 2018 at 09:13

Thresholds for intervention may be different in Spain though.

Lola, no point arranging a second PSA test. Even if it was slightly lower you would still worry that the new test was wrong and the 0.08 was correct.

His body may just be settling back into what is a normal level of PSA for him. Women that are breastfeeding could have a PSA of 0.08! Wait to see what the specialist says, and also what the normal point is for salvage treatment in Spain.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 08 Jun 2018 at 09:40

Posted 08 Jun 2018 at 10:16

Thanks for your response.

Do you mean your psa rised and then came down again? Do you think there's any chance my husband's psa goes the same way as yours and becomes lower than it is being currently, by itself?

Wel, I'm going to try to convince him to retest his PSA before his appointment.

Many thanks for your piece od advice.

Lola.

User

Posted 08 Jun 2018 at 10:47

Oh, Lyn, by accident I have deleted the post I had written to you. I was trying to delete another one that, again accidentally , was duplicated.

First I was saying thank you from my heart. Yo're allways there to help and support worried people.

You may be right. It's no good to have a blood retest. Apart from being so highly knowledged on this subject, you seem to be aware of my frequent anxiety and fears, and yes, I would possibly continue to be suspiccious about the new test fiability.

You said that PSA might be fluctuating until the body settles and get to the real PSA? Do you mean it could go down again?

The hospital's my oh is being treated criteria is that no treatment will be done as far as PSA is under 0.04, but I'm afraid most hospitals' critera is 0.02.

So, if I have understanood your words the right way, isn't it all that bad? I hope yes.

Luckily, now I'm capable of keeping my concern to myself and not let Paco know about it. I remenber you often used to advise me so. I'm behaving properly. Thanks also for your warning me on that.

Best wishes xx

Lola.

User

Posted 08 Jun 2018 at 10:57

I saw the first post so don't worry. And it is good that you are trying to behave!!! You have typed the numbers wrong here though - you meant 0.4 and 0.2.

If your hospital does not trigger salvage treatment until it gets to 0.4 then that is the way it is - no point you worrying that in England the NHS says 0.2 ... maybe the machines doing the testing are slightly different, or maybe the people who pay for treatment (is it private health insurance companies in Spain?) won't pay until it gets to 0.4. And yes, it can fluctuate a little so Franci's PSA went up a bit and then down a bit and my husband's has gone up to 0.11 and then back down to 0.09 and seems to just hover between the two at each test.

I don't think 0.2 or 0.4 would make much difference to the outcome - my dad is now up to 0.7 and his urologist is fine with him not wanting to have radiotherapy or hormones yet.

Edited by member 08 Jun 2018 at 11:27 | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 08 Jun 2018 at 11:05

https://community.prostatecanceruk.org/Scripts/tinymce/plugins/emoticons/img/smiley-laughing.gifI'm so glad to know that your men are doing well!

User

Posted 08 Jun 2018 at 15:38

Lynn

I believe the 0.2 threshold for BCR post RP s an international standard.

The study you can down load from here:

https://www.europeanurology.com/article/S0302-2838(17)30655-3/fulltext

Discusses the optimum (inc never) time and application of SRT to various post RP prostate cancer risk factors.

Other studies I have read seem to be saying the same thing - very low risk post RP (ie undetectable PSA with supersensitive test, PT3A or less and Gleason 7 or less) can chance it and wait for SRT, medium risk should get it done straight away and very high risk probably have no benefit.

User

Posted 08 Jun 2018 at 18:51

Rather irrelevant though since the threshold at Lola's OH's hospital is 0.4. It doesn't really matter what the threshold is for determining biochemical recurrence; it is the threshold at which a specialist, hospital or insurer would agree to start salvage treatment that can be variable.

The two thresholds are not necessarily the same. Take a man who has had radical RT / HT. The threshold for biochemical recurrence is 2.0 but based on the experiences of members here, the point at which an onco will restart treatment is usually 5 or 10 (or in Bri's case, the onco says 20 is the threshold and in another example on here this week, either 20 or 50)

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 08 Jun 2018 at 20:59

Irrelevant?? Lola may chose to go somewhere else or seek a different consultant if armed with knowledge she decides her current treatment options are not optimal. . BTW I am not saying they are! But isnt wider knowledge, experience and mutual assistance not the primary functions of this site??

User

Posted 09 Jun 2018 at 05:24

Thanks Francij1 and Lyn for your comments and help.

I've been reading the stuff from the link you posted, Feancij1, and yes, it seems to be 0.2. Also it is in most hospitals in Spain, and I think at our National Health Care aswell, I'm not sure. Actually I have asked myself why our uro insists on this criteria". Shall I think there is some reason for this? I hope they are doing correctly at this hospital (also an important hospital in Madrid), but on the other hand, something Lyn said (is it private health insurance companies in Spain?), makes me be suspicious. I mean, is this attitude a way to save money? We belong, apart from the National Health Care,as every Spaniard, to a pretty well known and reliable insurance company and, on this occasion, we are using it. (We only had to pay for the DaVinci), and now I'm afraid Lyn could be right. In case we came to that bad situation (cross fingers), I'm now taking account of that.

More opinions from you and from other members would be appreciated.

Best wishes,

Lola.

Edited by member 09 Jun 2018 at 05:26 | Reason: Not specified

User

Posted 09 Jun 2018 at 12:26

Hello Lola,

I realise I’ve had different treatment to you husband but my last four PSA results are - 0.01, 0.04, 0.08 and 0.18

My oncologist doesn’t seem too concerned and thinks it might even out, she said that unless it reached 2.0 they wouldn’t take any further action on my behalf.

Just to keep any eye on things she wants to see me in 4 months instead of the 6 monthly appointments I’ve been having.

Best wishes,

Arthur

Edited by member 09 Jun 2018 at 17:21 | Reason: Not specified

User

Posted 09 Jun 2018 at 17:51

Thanks for your response, Arthur. It helps me keep calm at the time I'm getting more information on this subject.

I'm glad to see you're doing well.

Best wishes,

Lola.

User

Posted 25 Jun 2018 at 05:50

HI all:

Two days from now, wednesday, my hub will meet his uro.

We've just got the result of his abdominal CAT he had done here, where we live. Taking it to Madrid tomorrow, for the doctor to see. It seems to be clear... prostate bed, liver, pancreas, bones, etc. But my concen continues to be his PSA rising from 0.04 to 0.08 during this year. He had Da Vinci one year ago.

I am scared. I'm imagining sitting at the uro's desk, facing him and listening to what he says.

I have a doubt, what is considered as "undetectable PSA"?

I'm not sure this blood test machine is "ultrasensitive" or a simple one. I'm a bit confused about it.

Comments would be appreciated.

Best wishes,

Lola.

User

Posted 25 Jun 2018 at 06:59

Ultrasensitive PSA test is anything that mesures below 0.1 so your figures are Ultrasensitive.

Pre Ultrasensitive less than 0.1 was considered undetectable simply because you could not detect PSA below this level. Many people still consider less than 0.1 as undetectable.

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