POST Radiation PSA movement

[Jmr11820]

I just received my first PSA result, 7 weeks post Radiation Therapy. The number is .01. My 1 month and 3 month PSA post prostatectomy were also both .01, then it crept up to .03 at 6 months. That was 4 months ago. At that point, mostly due to my high rick Decipher we decided to start radiation therapy. So now I'm 10 months post surgery and PSA is back at .01. Should I interpret this as a win at this point so soon after RT or might this simply be my PSA bouncing around at these low levels. I have yet to see a PSA test from my urologist's office that measures PSA out 3 decimal points. I'm going to ask about that tomorrow when I see him. Does PSA ever get to 0.00? In any case, I'm not sure what to expect in terms of PSA movement after radiation, so thought I'd reach out to the group. Appreciate your input.

[Tall_Allen]

I recommend you go in the opposite direction - ask for a conventional PSA test where the lowest value is 0.1. Otherwise the fluctuations as cells die will drive you crazy. There is absolutely nothing that you would initiate before PSA reaches about 2.0 anyway.

[Jmr11820 in reply to Tall_Allen]

Thanks. Crazy is right ! What about my 0.00 question, is that ever achieved is prostatectomy patients?

[Hidden in reply to Jmr11820]

I take it that you were not given any ADT with RT.

[Jmr11820 in reply to Hidden]

Correct

[tango65 in reply to Jmr11820]

Yes, it does and people with PSA less than 0.003 do not have BCR, according to this study by Dr. Alan Partin from John Hopkins:

hopkinsmedicine.org/brady-u...

[Jmr11820 in reply to tango65]

Thanks, yeah I’ve seen that. I appreciate Allen’s point but since I started RT at such a low number(.03), I don’t know how you’d gauge the effectiveness of treatment without the more sensitive PSA tests. I appreciate your response.

[tango65 in reply to Jmr11820]

I understand but you could get a lot of anxiety with small fluctuations of the PSA which will not indicate any actionable change in your treatment.

Best of luck!!

[Jmr11820 in reply to tango65]

Totally agree. Still, it would be nice to know if radiation is working after 35 treatments.

[Hidden in reply to Jmr11820]

I had a psa high of just twenty . I understand your view of it . I demand the ultra 3 digit test although it’s not Mandatory ... I like to know . I’ll flip out just like everyone else when it jumps . Until then I having fun . Don’t sweat the small stuff is the lesson .

[Tall_Allen in reply to Jmr11820]

It doesn't matter if it is achieved or if it isn't, PSA is not the goal - curing the cancer is the goal.

[Jmr11820 in reply to Tall_Allen]

👍👍

[Hidden in reply to Tall_Allen]

Makes sense ...

[Rocketman1960 in reply to Tall_Allen]

I am 100% on board with Allen in this advice.

[Hidden]

Good job getting through all that you’ve done already . God willing you’ll will get into the eye of the storm in the clear zone with me ,as in your photo above ... you are undetectable now . May you stay there and recover well . Then get back to life . I finished 8 weeks imrt olive years ago this month . It does take time to recover . Treat yourself well . Don’t worry about the minute fluctuation . You’re good and going to get better . Hang in there . 😎✌️

[Jmr11820 in reply to Hidden]

Thank you! The minor fluctuation was down so that’s good. Appreciate your kind words. Always positive, inspiring.

[Hidden in reply to Jmr11820]

The psychology of the PSA test can drive much anxiety . I’ve called it the Prostate specific anxiety test . I think that you’re good. 😎🌵

[Jmr11820 in reply to Hidden]

Thanks man! You’re a good guy.

[Hidden in reply to Jmr11820]

All of this technical stuff .. ? But T_A says2.0

Starts the race again ... get back to living and put the PSA out of your head for now. .. If it goes up then adt is due

[NecessarilySo]

I had radiation treatment in 2008 and the PSA fluctuated for three years afterwards from 0.4 to 0.8, then started to rise up to the 10 area, when hormone therapy was prescribed. I know everyone is different. Your high risk probably means castration resistant/hormone insensitive type of cancer cells. so I suppose that is why you are tested two decimal points. I suppose you need to watch more carefully than for the hormone sensitive type. I belive the advice that comes with PSA tests which is :

Roche ECLIA methodology.

According to the American Urological Association, Serum PSA should

decrease and remain at undetectable levels after radical

prostatectomy. The AUA defines biochemical recurrence as an initial

PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory

PSA value 0.2 ng/mL or greater.

Values obtained with different assay methods or kits cannot be used

interchangeably. Results cannot be interpreted as absolute evidence

of the presence or absence of malignant disease.

Note in particular the last sentence. I think what this means is that when radiation is applied, or when radical prostatectomy is performed, there is always the possibility that some healthy non-cancerous prostate cells remain in the body. Any cells that are not eliminated by the process are then going to cause a PSA reading, sometimes quite small. However, if there are "some" or any cells remaining, then PSA wouldn't or shouldn't ever reach zero.

Also, in your case, you need to wait for some time before worrying. You probably have some prostate cells remaining, a very tiny amount. Normal or noncancerous cells would not grow significantly and would die off before accumulating. Cancerous cells would grow but not die...eventually becoming tumors. Even so, the time before they become a concern is a matter of years, after rad therapy. In my case it was about 4 years later. Yours might be sooner, like two years. So check PSA every six months or so. I also think two decimal points is not so significant. Worry at 0.2 or higher.

[Jmr11820]

Thanks for your input. Much appreciated!