PSA slightly up after salvage radiation

[old64horn]

I was diagnosed with PCA Gleason 8 in 01/2009 and had prostatectomy in 02/2009. PSA <.01 for 8 years. in 2017 the PSA was, 0.1 (no less than sign). It continued to fluctuate and slightly rise until in became 0.12 in 2021. In June 2021 in started and 8 week IGRT/IMRT radiation of the prostate bed in adjacent lymph nodes. 1 month after completion the PSA was unchanged (0.12). 4 months after completion it is now 0.13. My question is: should the PSA be less than it was prior to radiation? Is this and indication the the cancer has metastasized? What scans are available that can show where the cancer is at this low PSA level? Thanks

[Tall_Allen]

It can take a while for the cancer in the radiated area too stop producing PSA. All you can do for now is continue to monitor. If in 3 months there is still no downward movement, you can consider systemic therapies if it increases, or you can wait if it is stable. What would you do with the results of a scan?

[old64horn in reply to Tall_Allen]

I guess at my age (80) I may opt for nothing if it is a very slow uptick or I can choose to do ADT to slow it down. If the scan can show where the PSA is coming from then may be local treatment to that are. I appreciate your input.

[Tall_Allen in reply to old64horn]

No known benefit from local treatment. I don't see how your young age enters into it.

[old64horn in reply to Tall_Allen]

Thanks for your responses. Are you the same Tall_Allen who used to post on Healingwell.com web site. I value your knowledge and opinion very much

[Tall_Allen in reply to old64horn]

Thanks. Yes, that's me.

[Don_1213]

My medical oncologist (well regarded) told me if PSA is >= 0.20 one can expect to see metastasis using PSMA-PET scanning. He felt at 0.20 to 0.15 - there is about a 50% chance of seeing cancer with the scan.

Dr. Eugene Kwon of the Mayo Clinic has a video on PSMA-PET scans that's worth watching (as are his other videos..) youtu.be/81iAzYV39Gw(Not working as expected?) - Part 1 of a 3 part series "DIY Combat Manual for Beating Prostate Cancer" - well worth watching all 3.

[old64horn in reply to Don_1213]

Thank for the video. It is very informative. I certainly will follow thru with his recommendations

[TJGuy]

Incredible run with Gleason 8 at age 68 now 80 with 0.13 increasing by 0.01 in 4 months. WOW!

Curious what you were told back at diagnosis to expect.

Your PSA was a much closer to a REAL undetectable at <0.01 (than the <0.1 often cited) and for so long. CONGRATULATIONS!

Seams you might be "the one in a million" who out lives this to a very old old age.

Since you've apparently done all this off ADT chemo etc. I wouldn't be in any rush for treatments and all the negitive side effects.

Dr Kwon would be a good source for opinions on your future care if any at this time.

Keep track of your cancer with both quartly PSA test and probably annual PET scans. Your doing Great!

[old64horn in reply to TJGuy]

My surgery was 02/09/2009. My pathology report showed only 2 areas with cancer (4+4) Extra prostatic extension and negative margins and only 15-20% involvement. No lymph nodes were tested. My doctor suggested to monitor the PSA which I did for 8 years until it 2017 when it was 0.01. when the PSA reached 0.12 my doctor suggested salvage radiation which was completed 0m 8/23/2021. Here I'm now at 0.13 to low to do any type of imaging. My doctor wants me to do another PSA test in 4 month and see whether it goes up or down.I may have ADT in my future. Thanks for your input. I will try to consult with Dr Kwon at least via zoom and see what he suggests. He is big on PET scans but at this level of PSA and may not show anything.

[ishitasen]

Ideally after radiotherapy your PSA should have shown a decreasing trend. At present PSMA PET CT is the most sensitive testing available now. If you are worry about your disease recurrence you can get a PSMA PET CT scan to know latest disease status.