Re: Differing PSA test methods - EIA vs ICMA - how much do they vary?

March 14, 2007

It is possible that the 2 month interval between tests is a factor. Your PSA could have possibly increased that much. I do not think the vitamins had any effect on it. Have another PSA test. You may need a biopsy to eliminate uncertainty.

Good luck

"il faut d'abord durer." Hemingway

Differing PSA test methods - EIA vs ICMA - how much do they vary?

I am new to all this and it is all a little overwhelming.I had a PSA test 2 months ago with a reading at about 7.6 by theAbbott EIA method which I have been told is the "gold standard".Two months later a different lab did a second test using a differentmethod (Beckman - formerly Hybritech - ICMA methodology) and they cameup with a 9.5. Free PSA tested at 23%. Combined with a normal DREexam - the JAMA printout for my age (59) gave me a less than 10%probability of cancer. Yet the urologist said my risk rate could be50-60%. In that 2 month time frame, I had stopped taking all vitamins.QUESTION: Has anyone known PSA level to vary so much from one PSA testing methodto another and from the withdrawl of vitamin supplements?My Dad had BPH for at least the last 30 years of his life age 56 to 86and I do have a slightly enlarged prostae with occasional, recurringsymptoms of BPH and urinary tract infections.

March 14, 2007

I had a similar jump late last year (5.4 to 6.6 in 2 months) and I was told by the doctor that several things could effect the PSA reading. One was differences in lab and testing but he said more likely was activity that might stimulate the prostate. He suggested making sure I abstain from sex for three days prior to the blood test, avoid riding a bicycle or motorcycle and he said some men even claim that using a rowing machine at the gym have an effect. He also said make sure the doctor draws blood prior to doing a DRE. The doctor claimed that any of the above could increase the PSA from 40% to 60%. Again, I do not claim to know if any of this is true, maybe Aubrey or someone else could verify this for us, but that is

what my doctor claims. You would think a doctor would have informed me of this after the first elevated PSA.

Age 57

Gleason 3+3=6

PSA 6.6 (December 2006)

Differing PSA test methods - EIA vs ICMA - how much do they vary?

I am new to all this and it is all a little overwhelming.I had a PSA test 2 months ago with a reading at about 7.6 by theAbbott EIA method which I have been told is the "gold standard".Two months later a different lab did a second test using a differentmethod (Beckman - formerly Hybritech - ICMA methodology) and they cameup with a 9.5. Free PSA tested at 23%. Combined with a normal DREexam - the JAMA printout for my age (59) gave me a less than 10%probability of cancer. Yet the urologist said my risk rate could be50-60%. In that 2 month time frame, I had stopped taking all vitamins.QUESTION: Has anyone known PSA level to vary so much from one PSA testing methodto another and from the withdrawl of vitamin supplements?My Dad had BPH for at least the last 30 years of his life age 56 to 86and I do have a slightly enlarged prostae with occasional, recurringsymptoms of BPH and urinary tract

infections.

March 14, 2007

Hi there,

I am sure that most of us can relate to

just how overwhelming it is when first diagnosed. You’ll find I am

sure that gradually you will be able to see the wood from the trees and then

even be able to see what kind of trees they are!!

There

is a significant difference between the results of PSA tests from

different manufacturers. I have never heard of any one test as being

described as the “gold standard” – this term is often

used where the ‘standard’ generates the most gold!! When PSA

testing was first introduced the differences in readings between the

different protocols caused an enormous amount of confusion, so all the

manufacturers got together to agree a standard approach – this is

what is known as The Stanford Protocol. It is not binding on any laboratory

so some laboratories will still report the results they get from their

methodology while others will adjust their results to the agree standard. This

is one of the reasons why the PSA test results are not very accurate –

most labs will only guarantee an 80% accuracy for any test, which is why

the results should be reported as a range with a mid-point. So your two results

are not strictly speaking comparable – and incidentally, just to

confuse the issue a little bit further, there has been no agreement on the

standardization of ultra-sensitive or free PSA results, so they are NEVER

directly comparable between differing protocols.

As

you probably know, the free PSA percentage varies in indirect proportion

to the potential for prostate cancer. The odds are higher below 15% that

the PSA will be PCa generated. Your free PSA percentage of 23% is very

close to the accepted limit of 25% beyond which it would be unusual for

the PSA to be generated by prostate cancer. This is NOT a hard a fast

rule, merely a statistical indication. I am a prime example of this

because my free PSA has been as high as 48% and yet I had been diagnosed

with PCa – the big question was (and stillis – how much of my

total PSA was generated by the tumour?)

Your

BPH and recurring prostatitis are much more likely to be the source of

your elevated PSA than PCa.

There

are a number of activities that can alter the PSA readings significantly.

Various studies have demonstrated these and they are shown in these

two studies – hope the table keeps shape for you, if not you may

like to go and read a small piece I wrote entitled PSA 101 to help people

gain a basic understanding at : http://tinyurl.com/8x6my

The

following listing of physiologic conditions and manipulations that affect PSA

serum levels is a from S Yox: “To Screen or Not to Screen? The Controversy

Over Prostate Cancer.” Laboratory Medicine V29, No 8. Aug/98.

Condition/Manipulation

Increase

Effect on PSA Level Persists

Up To

Acute bacterial

prostatitis 5-7

fold

6

weeks

Acute urinary

retention 5-7

fold 6

weeks

Digital Rectal Exam

(DRE) Variable

3

days

Exercise - bicycle

0-3

fold

1

week

Prostate

biopsy

Very

Variable 6

weeks

Prostate

massage

Variable

6

weeks

Ejaculation

Variable

3

days

TURP

Very

Variable 6

weeks

This

article on the reliability of PSA Readings

is also informative, I think.

Figures from Roehrborn et al, " Variability of repeated

prostate-specific antigen measurements within less than 90 days in a well

defined patient population. " Urology 1996;47:55-66.

·

295 men were identified who had 2 PSA readings within 90 days and

who had a first reading of less than 10 ng/ml (Abbott IMx).

·

Only 6% had 2 identical readings,

·

64% had a second reading with a difference between

- 1.0 and + 1.0 ng/ml compared with

the first.

·

In 30% it was more than +/- 1.0. Of these

·

18% (53 of 295) had a PSA difference

between +/- 1.0 and +/- 2.0;

·

7% (20 of 295) between +/- 2.0 and

+/- 3.0;

·

5% (16 of 295)of more than +/- 3.0.

·

The largest PSA differences recorded were -5.3 and

+7.5 ng/ml.

·

In total 46% had a increase or

the same PSA on second reading, 54% a

decrease.

Of these 295 men 168 had

normal prostates on DRE, 96 BPH and 31 suspicion of cancer. There was no

variety in PSA differences among these subsets and neither age or height of the

initial reading affected results.

(These

differences may be the result of the mixed effect of random errors, batch

inequalites, so-called " physiologic variations " and transient effects

of concomitant prostatitis.)

The

last point above is an important one – the inexplicable changes in

PSA levels. You may be interested to see the results of a small experiment

I undertook six years ago when I had daily PSA tests to see if there was

any variance, as there is with other tests like testosterone, over that

period. I did everything I could to stabilize the results yet there were significant

daily changes – in one three day period the PSA numbers went from

4.5 ng/ml to 6.00 ng/ml and then dropped back to 4.6 ng/ml a few days

later.

The

question of vitamins and supplements altering the PSA is a difficult one

to answer because of the inherent inaccuracy of the PSA test. What we have

observed from reports from men with PC a over the years (as opposed to any

specific study) is that a PSA will often drop after diagnosis when the man

changes his life style – eats better, starts exercising more, tries

to de-stress, takes supplements. When this happens, the PSA tends to

start rising after some time and often then remains at the level it

was previously.

Hope this all helps a little in the

de-mystifying process, but mail again if it doesn’t.

All the best

Terry Herbert

in Melbourne Australia

Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason

3+3=6: No treatment. June '04: TURP. Feb '07 PSA 30.4

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one

knows what he doesn’t know, and the less a man knows, the more sure he is

that he knows everything. Joyce Carey

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of tkts110

Sent: Thursday, 15 March 2007 9:04

AM

To:

ProstateCancerSupport

Subject:

Differing PSA test methods - EIA vs ICMA - how much do they vary?

I am new to all this and it is all a little

overwhelming.

I had a PSA test 2 months ago with a reading at about 7.6 by the

Abbott EIA method which I have been told is the " gold standard " .

Two months later a different lab did a second test using a different

method (Beckman - formerly Hybritech - ICMA methodology) and they came

up with a 9.5. Free PSA tested at 23%. Combined with a normal DRE

exam - the JAMA printout for my age (59) gave me a less than 10%

probability of cancer. Yet the urologist said my risk rate could be

50-60%.

In that 2 month time frame, I had stopped taking all vitamins.

QUESTION:

Has anyone known PSA level to vary so much from one PSA testing method

to another and from the withdrawl of vitamin supplements?

My Dad had BPH for at least the last 30 years of his life age 56 to 86

and I do have a slightly enlarged prostae with occasional, recurring

symptoms of BPH and urinary tract infections.

March 14, 2007

Thanks Terry

Great information

[ProstateCancerSupp ort] Differing PSA test methods - EIA vs ICMA - how much do they vary?

I am new to all this and it is all a little overwhelming.I had a PSA test 2 months ago with a reading at about 7.6 by theAbbott EIA method which I have been told is the "gold standard".Two months later a different lab did a second test using a differentmethod (Beckman - formerly Hybritech - ICMA methodology) and they cameup with a 9.5. Free PSA tested at 23%. Combined with a normal DREexam - the JAMA printout for my age (59) gave me a less than 10%probability of cancer. Yet the urologist said my risk rate could be50-60%. In that 2 month time frame, I had stopped taking all vitamins.QUESTION: Has anyone known PSA level to vary so much from one PSA testing methodto another and from the withdrawl of vitamin supplements?My Dad had BPH for at least the last 30 years of his life age 56 to 86and I do have a slightly enlarged prostae with

occasional, recurringsymptoms of BPH and urinary tract infections.

March 14, 2007

TO: Terry, and - Sincere thanks for your valuable input.

This forum is helping me feel better already. I know there are

hundreds of thousands - probably millions of men with prostate

problems out there - but to actually be communicating with some of

them directly is a wonderful use of the internet.

I have just started a regimen of Lycopene, with selenium and Vitamin E

(all at once)3 days ago. I will be adding Pomegranate juice tomorrow.

I have also launched into a mild exercise program and am working on

losing weight to get from 200 to 180 on my 5'11 " frame.

Curiously, my urologist showed no regard for these things yet the

waiting and exam room were filled with literature endorsing them.

It's 3 doctor practice so I guess I got the non-believer in the group.

I have read enough to believe these things work for some and I have

witnessed medical miracles in my life. Our son - born to us 4 years

ago - was one of them. I also know that a positive attitude can go a

long way to having real and positive physical effects.

Best wishes to all of you on this forum I plan on being here often.

March 19, 2007

Has anyone posted any detailed informantion on the FREE PSA

or PSA FREE test? Supposedly, it may be more accurate.

Also I heard that one's urologist must send that blood sample

off to a different lab, one equipped for PSA FREE testing.

Would be interesting if someone could elaborate what that

FREE PSA test is all about?

My urologist also sent off a sample of my blood last year,

for a further " blood test, that could show test markers,

indicating cancer was present either in body, or in

prostate " . I don't know what that test was - but I will

ask my urologist when I see him next month.

So far I've " learned " that PSA testing could vary by:

a. Regular PSA test

b. FREE PSA test

c. Whether man has had recent sexual activity, shortly

before PSA test.

d. Size of the man's prostate - taking PSA test.

e. Accuracy measurement differences in different PSA test labs.

I guess there are some variables here.

Fred

Spring Hill, FL

>

> I am new to all this and it is all a little overwhelming.

>

> I had a PSA test 2 months ago with a reading at about 7.6 by the

> Abbott EIA method which I have been told is the " gold standard " .

>

> Two months later a different lab did a second test using a different

> method (Beckman - formerly Hybritech - ICMA methodology) and they

came

> up with a 9.5. Free PSA tested at 23%. Combined with a normal DRE

> exam - the JAMA printout for my age (59) gave me a less than 10%

> probability of cancer. Yet the urologist said my risk rate could be

> 50-60%.

>

> In that 2 month time frame, I had stopped taking all vitamins.

>

> QUESTION:

> Has anyone known PSA level to vary so much from one PSA testing

method

> to another and from the withdrawl of vitamin supplements?

>

> My Dad had BPH for at least the last 30 years of his life age 56 to

86

> and I do have a slightly enlarged prostae with occasional, recurring

> symptoms of BPH and urinary tract infections.

>

March 19, 2007

Fred,

I guess you haven’t followed my

suggestion that you go along to read the piece I wrote to explain the basics of

PSA at http://tinyurl.com/8x6my If you had done so you would have seen this, amongst other

information, including the variables:

<SNIP>

When the PSA test was introduced in 1990 a reading of more than 10 ng/ml was

regarded as one that should be investigated further. This figure was

subsequently reduced to 4.00 ng/ml, which is regarded as " normal " in

most countries and by most medical people. In the US there is a move to reduce the

limit to 2.60 ng/ml or even to 1.25 ng/ml. On the other hand, one leading

expert physician feels that any PSA result under 12 ng/ml is not worth being

concerned about, unless there are other symptoms. Between 25% and 35% of men

with a PSA reading of between 4.00 ng/ml and 10.00 ng/ml will be found to have

prostate cancer.

If any

PSA result is between 4 and 10 ng/ml, and provided there has been no treatment,

a second test should be run - the so-called fPSA, PSA II or Free PSA test. This

doesn't mean that you don't pay for it. It refers to the amount of what is

referred to as " unbound " PSA.

The

result of this test will be shown as a percentage of the total PSA measured.

The risk of cancer being present varies in inverse proportion to the percentage

shown. So the higher the percentage, the less chance that there is of the PSA

being caused by prostate cancer. A fPSA of over 25% would mean that the most

likely cause of the elevated PSA is not prostate cancer: a fPSA of under 15% is

strongly correlated with prostate cancer. There are some studies which show

that the fPSA test may be valid for readings between 2.5 ng/ml and 20 ng/ml. <SNIP>

Alternatively you could have gone to

Google, entered Free PSA and found over 1 million hits – the first

handful would have given you all the information you needed.

All the best

Terry Herbert

+61 3 9891 6883

+61 421 907 318

: terryherbert1942

1/60 Morna

Rd,

DONCASTER EAST VIC 3109,

Australia

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of ncsailors