PSA jumped after radiation

[auroracham]

Hi. I finished two weeks of radiation today. I do feel better but exhausted. Question I have is I had my PSA checked Wednesday. Last month it was 2.55. Mine never drops low like many of you talk about with Lupron, Prednisone, Zitiga. This month it jumped to 4.45. have others experienced a jump during radiation? None of my nurses seem to know, neither at radiology or oncology.

[Tall_Allen]

PSA always jumps immediately after radiation - that shows there are lots of dead cancer cells releasing their PSA into your bloodstream. If that didn't happen, you should have been worried.

[jdayoc in reply to Tall_Allen]

Allen- In my short tenure as part of this group, I have quickly gained great respect for you. As such, I wish to seek your opinion. A friend sent me a video (don’t know it’s date) by Dr Eugene Kwon with Mayo Clinic entitled “OligoMetastic Prostate Cancer Disease...” wherein he laments the palliative protocols and touts aggressive, curative treatments. The key is to locate mets via choline 11 pet scan, then zero in and kill/remove the met. Depending on the characteristics, location of the met, treatment may be radiation or surgery. This past Friday, I completed 39 radiation treatments for biochemical recurrence...had prostatectomy on 3/31/17 (post pathology report Gleason score 9 and cancer <.1cm in two lymph nodes.) After watching this video, I think Dr Kwon’s approach should be my next step when and if my PSA starts to increase again. Of course, my first PSA will not be until May 29th. I respectfully seek Your opinion. Thank you! Joe

[Tall_Allen in reply to jdayoc]

Hi Joe, and thanks for the kind words. Yes, I've seen the video - patients have mentioned it to me often. I do have many issues with it and think it is misleading. I think Kwon had good intentions but ultimately does patients a disservice by not making clear that he is only expressing his opinions up until the very end, and presenting all these "gee whiz" cases without balance or explanation. I can only emphasize the importance of getting information from reliable sources (i.e., high level-of-evidence publications in peer-reviewed journals rather than random places on the internet and youtube videos).

• It was a presentation to patients, not doctors. He is obviously trying to give patients with metastatic disease hope. If he went further than the data allow, his heart is in the right place. As he stated at the end, he was offering his opinions, not facts.

• He showed a score of before and after PET scans, showing how radiation or surgery can result in excellent LOCAL control of detectable metastases. PSA disappeared along with the mets, as we would expect. Ironically, he started the presentation with half a dozen cases where patients died despite no detectable PSA, and said we have to be cautious about using PSA as the only tool to monitor progression.

• In all the cases but a couple, he offered 2-year PSA control as the outcome. Two years is not enough.

• Case studies are very useful for forming hypotheses. Pubmed is full of case studies of "miraculous" remissions. Kwon did not show the cases where it didn't work, except one. This is where science comes in - observations like his have to be tested in randomized clinical trials. "Gee-whiz" presentations are exciting, but what we want to know is if it really works, how much it works, and in whom it works.

Oddly, I have not seen any announcements of a such a randomized clinical trial from the Mayo Clinic. Last year, they began a non-randomized trial in castration resistant men, but that's all I've seen from them so far. There are randomized clinical trials that are ongoing in London and Montreal that will have larger sample sizes and are scheduled to run long enough to detect survival differences.

I would also ask you to read the following article, which cites what the actual evidence about this is:

pcnrv.blogspot.com/2017/05/...

(apologies to the OP for the digression)

- Allen

[jdayoc in reply to Tall_Allen]

Allen- Thank you so very much for “the rest of the story”! I greatly appreciate you taking the time to provide such a detailed response, especially today! Have a Blessed Easter! Joe

[rococo in reply to jdayoc]

Always good to be proactive an pre plan Some call it having an ace in the hole. If anything gives yoy some peace of mind. The best. Rpcco

[auroracham in reply to rococo]

Thanks for reply. PSA dropped to 3.1 now. Feel better about it. Mine always seems to be in the 2 to 3 range, but didn't like the 4.45. Have a great rest of your day.

[westof in reply to Tall_Allen]

Hi Allen, finished 25 days of IMRT 7/8 and PSA test 8/9. Score is still at 0.014. Any cause for concern? How is "immediately" defined?

Thanks

[Tall_Allen in reply to westof]

You have to wait 3 months for a first reading

[Etoile3 in reply to Tall_Allen]

My dad finished his brachytherapy and EBRT on August. He did on September and December the blood test and his PSA is less than 0.1. The doctor said wonderful. He didn’t have that jump . You said if that didn’t happen, there is a problem. I am really confused. Please , could you give more details.

[Tall_Allen in reply to Etoile3]

PSA < 0.1 is great! He is still taking Lupron, right? So of course his PSSA is undetectable.

[Zot1 in reply to Tall_Allen]

Yes , he takes Eligard every 3 months. I am still confused when you say : « PSA always jumps immediately after radiation - that shows there are lots of dead cancer cells releasing their PSA into your bloodstream. If that didn't happen, you should have been worried».I thank you very much for taking time to answer to our concerns.

[Tall_Allen in reply to Zot1]

You read that in my response to auroracham, not to you. Unlike you, he is not taking Lupron. I know it is difficult on a forum like this when you mistakenly think someone is in a similar situation, but they are actually very different.

[spinosa]

Tall Allen is correct! I recently finished 40 "salvage" radiation treatments for recurrent PCA (PSA at .2) - my rad oncologist said, well... we can check it (PSA) in 3 months, but 6 may be better since the death of PCA is slow with radiation (heck, it's a bit slow with surgery - I didn't have a PSA post-op for 3 months)...and, there is the "bump" phenomenon Tall Allen references. If you read Patrick Walsh's book, Surviving Prostate Cancer, he notes that the "nadir" with radiation may not be reached until two years after treatment (6 months to 2 years).

[auroracham in reply to spinosa]

You folks are great. Thanks. I suspected but my nurses knew nothing. Pain is better. Big trip in three weeks. Wanted relief and I think I got it. Just wanted to know about PSA jump.

[auroracham in reply to spinosa]

Do you have stage 4? I do and treatment is only for pain. Will not get rid of it. What is your PSA after bump from .2? Curious? Please give me more history. They give me about 4 to 5 years.

[lincolnj8]

Are you at stage 4 like I am?

[auroracham]

I am. Aggressive. Wish otherwise. Making the most of my time.

[Hidden]

As one who 15 years ago had seeds implanted and a short course of 25 sessions of IRMT (planned primary treatment), my PSA never really came down. Started at 6.8, Gleason 7(4+3), my PSA never really came down. Bounced from 9.0 to 12.6 for six months after IMRT. Treated by Cipro, Bactrim, Indocin, and Urimax as it was felt that I have inflammation and infection. At seven months, PSA was 25.2; then 30.2, and finally 32.3. Had another set of scans revealed two mets and I received my first injection of Lupron, at one year. Point is that I had monthly PSA tests. They are not expensive and, at the time monthly PSA tests were standard protocol the month after internal and external radiation.

In my opinion what has taken place commencing six years ago when the U.S. Preventative Task Force recommended that PSA tests were too frequent and only served as a fear factor. To this I call, BS! Not one Prostate Cancer specialist served on this task force, neither Urologist nor Medical Oncologist; the bulk of which consisted of non-Physicians. Why?

Again my opinion, medical costs in preparation of socialized medicine; not lives. Is it me, or are most cases of Prostate Cancer today, designated as Advanced Prostate Cancer. In other words, I keep reading about men who when first diagnosed are diagnosed with involved cancer at Stage 4.

More emphasis is placed on Breast Cancer with very large sums of money raised for this research and more public awareness through early detection. Why? I understand that the mortality rate of Breast Cancer has fallen 10% in the past ten years while the mortality rate of Prostate Cancer has increased 10%,

My point, insist on monthly PSA tests. My case? I have had 85 PSA tests since diagnosed with Prostate Cancer on March 3, 2003. I had monthly test for the first three years; then went to quarterly for nine years and finally every 120 days for the past three years.

My best advice, stay aggressive in the management and treatment of your cancer.

Gourd Dancer

[mikell in reply to Hidden]

Gourd_dancer, yours is an old post. I hope you are still doing well, as you appeared to be some three years ago. Your path appears different than mine but you did eventually get mets. I started with a single bone met, they did not go after the met immediately but rather ADT, which I have always thought they intended as palliative. Now, it's 4 years later, my bone mets have increased, last scan said 3 spine, multiple rib, one or more hip, etc. Moved from Lupron to Firmagon to Zoledex. Never got to PSA under 3 and am considered castrate resistant. I started on Xofigo (radium223) injections 5 months ago. About to receive 6th. In that time my PSA has gone from about 20 to 200. The Xofigo Dr. is not concerned, I am. I get PSA tests every 2 weeks. While my PSA has gone up rapidly, my Alk went from over 200 to about 60. Big question; is the PSA rise from cancer cell death or spread.

[Hidden in reply to mikell]

Mikell, I have been most fortunate, I still maintain <0.1 PSA with an average of 550 T. The day I found out that I had mets and received my first injection of Lupron, my RO told me that anyone could give me Lupron and that I did not have to drive 200 miles one way anymore. I told the doctor that I had one question..... “Doc, if you were in my shoes, just diagnosed with mets, what would you do?” He thought a moment and replied that he would find the best medical oncologist around that specialized in PCa....l not any other cancer. Someone on top of their game; perhaps academia and research. “Doc, do you know one?” The answer was that he did not,

The next I was with my other RO ( the first did Brachytherapy the send IMRT). I asked the same question and received the same response, but this one then said that he sat on a SPORE committee with one and that he would call him,

Short story is that by the time I got home and hour later, the phone rang and I had an appointment the next day. If I had not asked my question, I would have had the standard treatment for metastatic prostate cancer.

I enrolled in a clinical trial with an academic research; a professor at a leading medical school..... a guy who taught young oncologists their trade. Yes, I was most fortunate....

I hope that everything works out for you. Gourd Dancer

[Robertleeb]

I had radiation treatment and Hormone therapy , my PSA dropped to .4 from 9. it is at .1 and has been there for two psa tests.

[Cisco99]

Same situation as me. I was told to not even bother checking PSA until the effects of the radiation wound down.

[timotur]

ascopost.com/News/18642

“The first PSA bounce after radiation therapy was identified at 17 months (95% confidence interval [CI] = 15–18 months). This finding was in contrast to patients who experienced biochemical failure; for them, the median time to a first PSA bounce was 41 months (95% CI = 28–53 months). In total, 33% of patients experienced at least one PSA bounce. The median magnitude was 1.0 ng/mL (range, 0.4–17.0 ng/mL). Patients 70 years and older were more likely to have a PSA bounce. On multivariate analysis, the sole identifiable predictor of a likely PSA bounce was a Gleason score of 6.”