PSA rise in the first year after SBRT - Advanced Prostate...

Advanced Prostate Cancer
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PSA rise in the first year after SBRT

wa64hoos
wa64hoos

anyone had a rise in PSA after 8 months following SBRT. Had increase from 0.9 to 1.3 at month eight and now at 1.54 at month eleven. Original PSA never higher then 3.5. Gleason 3-3, 3-3, 3-4, 3-4, 3-4 5 cores involved. no core more then 30%.

2months after SBRT 3.4 dropped to 1.9. Three month later the 1.9 dropped to the

.9 mentioned above then the increase to 1.3 and later 1.54. The urologist following me says he was not concerned, radiology patients have changes

in PSA. He wants to continue PSA testing every 3 months as we have been doing.

I am thinking of returning to the Oncology Radiologist for a consult since she did the treatment and has seen more PSA changes like this in the first year.

Anyone have any opinion on what I am thinking?

21 Replies
oldestnewest

Biochemical recurrence after radiotherapy is defined as nadir plus 2. You nadir was 0.9 and your PSA is 1.54, far from 2.9 . You should be followed by a radiation oncologist and an oncologist specialized in prostate cancer.

A PSMA PET scan may be well in order.

If we were in 2025, you would probably had this test before starting SBRT.

Fast reverse to today's 2019 you will "learn" that this test is not for your current condition, yet, if you want to burn some money, you can have it. (speaking from personal experience).

jnm.snmjournals.org/content/60/2/234.full.pdf

wa64hoos
wa64hoos in reply to justfor

Other then an MRI( my suggestion) before I would consider even a biopsy no suggestions for other scans

were made. I suppose that was based on my original PSA (3.5) and somewhat modest(intermediate) gleason findings. Than you for your input.

That's a great response so far. Congratulations!

wa64hoos
wa64hoos in reply to Tall_Allen

I thank you Tall-Allen. I did SBRT after reading your messages and hearing your very

good responses last year. Last week after hearing my general urologist insist my first

year PSA increases did not concern him, so far. I had read about PSA bounces after radiation

and initially agreed with him. A few days later I considered the fact he was not a radiation

oncologist like the woman whose clinc I had the SBRT performed. So, in a couple of days I have an appt. with her to discuss my concerns. Your reply does make me less concerned

and I do appreciate your message.

Tall_Allen
Tall_Allen in reply to wa64hoos

It is unusual for a urologist to be so knowledgeable. Your RO should have told you to expect bounces and they are a good thing - not a cause for concern.

pcnrv.blogspot.com/2018/03/...

PSA reduced from 745 to 0.727 in just 4 months with the help of luprolide and 4 sessions of chemo

wa64hoos
wa64hoos in reply to Nick2019

sounds very encouraging! Thanks for your response.

Whimpy-p
Whimpy-p in reply to Nick2019

Bravo! Way to go .. that’s a huge drop 👏🏼

My experience is similar. Initial diagnosis:

PSA10.4

Guided Artimous Biobsy, Gleason Score: 3 cores 3+5; 88%,92%,100%

1 core 3+4, 2 cores 3+3, perinural invasion noted in 3 cores

Bicalutimide started Oct 2018, 5 SBRT sessions finished Jan 4 2019

5 Feb PSA .8

15 Apr PSA .4

3 Jun PSA .4

15 Aug PSA .75

My radiation oncologist said PSA Bounce normal 9-18 months after SBRT. Should go back down. No need for further action unless it goes above 2.

wa64hoos
wa64hoos in reply to marmigs

not sure my response to you got thru. I have read about PSA bounce and hope that is what I am having. Thanks for your input.

Hi wa64hoos,

Don`t worry because it can be the so-called "bounce effect" or "bounce phenomenon".

The psa will rise to a certain level and will gradually decrease later.

On the internet you can find a lot of information on this subject, for example from Journal of Contemporary BRACHYTHERAPY:

"Time to PSA rise differentiates the PSA bounce after HDR and LDR brachytherapy of prostate cancer" from 2018 Feb.

I guess you don`t take Bicalutamide (Casodex) or any other medicine?

wa64hoos
wa64hoos in reply to donits

I am not sure my response to you got thru. In any case my diagnosis and radiology treatment did not include any medication at that time. That may change depending on my ultimate

response to the SBRT. Thank you for your suggestions

The PSMA PET CT might be worthwhile

Ten years ago I had radiation after early diagnosis and a low Gleason score

My PSA hovered around 1..5 to 1.9 but never lower. In 2014 a had a PET CT that indicated the involvement of lymph nodes.

The test is covered by a lot of insurance carriers and is worth it

Thanks, I will see what the radiation oncologist says in a couple of days. Your background

from ten years ago and your responses seem similar to my responses after this first year.

Unfortunately I ended up waiting 4 years to get that PET CT

And hence had two 8 eight surgery to remove 72 lymph nodes

And then two rounds of cyber knife radiation. Now on long term lupron therapy.

I would also recommend find a good oncologist that specializes in prostate CA

Good luck

Agree with the recommended following of PSA. But if it should becomes evident that there is biochemical recurrence I would explore with your radiation oncologist the possible role of brachy-boost treatment, even though you appear in a less aggressive, less advanced situation (happily).

It is worth having the conversation about it anyway. Here is some information:

pcnrv.blogspot.com/2017/03/...

pcnrv.blogspot.com/2018/03/...

wa64hoos
wa64hoos in reply to MateoBeach

Yes, I had read about the brachy-boost treatment after SBRT results turn out less then

optimal. I will ask her about possible options should that be the situation. Thanks

for your input

PSA = Permanent Stress and Anxiety

j-o-h-n
j-o-h-n in reply to dadzone43

UGOTIT.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 10/13/2019 8:05 PM DST

Yes I have heard of it in many and it is not good. Seek a prominent oncologist or they'll just shoot you with Lupron.

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