PSA Rise

[caysary]

Hello distinguished gentlemen. Diagnosed Dec. 2020. 4+3 Did SBRT + 4 mo ADT. Oct 2021. My PSA is acting strange. Could you please give me advise as what this rise could be attributed to? Thinking of PSMA Scan and MRI.

[tango65]

Since your PSA has increased more than 2 points above the nadir, it could be a BCR. I would discuss having a PSMA PET/CT to see if there is cancer and where is located.

[caysary in reply to tango65]

Wow. I was hoping at least 5-10 years. Does this resemble a radiation bounce at all?

[tango65 in reply to caysary]

The definition of BCR after radiotherapy of the prostate is 2 points above the nadir, The PSA has continue to increase in 4 subsequent PSA measurements, pretty consistently.

You could have a prostate infection which could also cause an increase in the PSA. Discuss with your doctor how to proceed,

[caysary in reply to tango65]

Understood tango65. Thank you. I have a mild burning sensation during urination and awkward discomfort from ejaculation.

[Tall_Allen]

When your ADT wore off, the PSA rose to what it would have been without the ADT. The PSA rise may be due to prostatitis or "zombie cells" (cancer cells that have effectively been killed by the radiation but haven't yet disappeared.). I'm not sure scans can distinguish those benign cells from cancerous ones. Probably, your RO is advising another PSA test in 3 months.

[caysary in reply to Tall_Allen]

Appreciate the comment Mr. TA.

[EdBacon]

Could be recurrence. I'd get another PSA test and see if it continues to rise. May need to go back on ADT at that point.

[MateoBeach]

It appears the large rise in the first few months after SBRT were also while you were on the 4 month ADT. That most likely is the well known “bump” as dying cells release their contents including PSA. Then you had a very fine decline to a nadir in Jan 2022. The steady rise after that likely corresponds to additional sites of cancer that may have been too small to be identified on scans prior to the SBRT. Such recurrences are common (66%) within two years after SBRT.I would ask for another PSMA PET scan and Whole body CT. At current PSA the scan should show additional sites. If so and they can also be irradiated then that is fine. But not sufficient. Wack-a-Mole tends to be futile. If all identified sites can be treated with RT, then you need a systemic treatment to control what you can’t yet see. Long term treatment with ADT PLUS an advanced AR drug would be standard. Chemotherapy is another choice. I personally opted for Lu177 treatments as described in my previous posts. (Not SOC)

[caysary in reply to MateoBeach]

Sure. Just to clarify. I was on 4 mo ADT July 2021 and started SBRT October 2021. I also am experiencing mild urinary and ejaculation discomforts which I will have to bring up to the ROs attention.

[Hidden]

Not the news that you want to hear if you comparatively follow my track. Gleason 7 at 6.8 PSA in February 2003. Brachytherapy in April 2003 with 25 sessions of IMRT finished in August 2003. PSA never really came down. By February 2004, PSA at 12. April 2004, PSA at 32.4 with nuclear bone CT scans confirming Mets to T3 & L2 the first week of May 2004. I previously had four nuclear bone scans with corresponding soft tissue CT scans; all negative.

Yes, during the period of December to March, I too was treated with various drugs for possible “infection” and monthly PSAs.

Explained as micro-metastases taken place before original diagnosis in February 2003. I took my first Lupron injection on May 7, 2004. I continued with Lupron/Eligard until February 20, 2010, at which time I had to be convinced to stop and see what’s going on knowing that the only downside was to restart ADT. By this time I had undergone 26 sets of nuclear bone scans with CT scans. I am most fortunate with undetectable PSAs since October 2005.

I have written extensively on my treatment path in academia - medical school professor and researcher and his six month clinical trial of chemotherapy with Lupron/Eligard. BCR was never a term mentioned nor used; but rather micro-metastasis.

Research and understand the term; discuss with your medical oncologist.

I wish you good fortune in your treatment. Best advice that was given to me when I asked, by two different ROs from my primary treatment - find the best damn medical oncologist that has researched and treated metastatic prostate cancer who is on top of their game - preferably one who teaches others their trade and has flexibility through research,

Gourd Dancer

[caysary in reply to Hidden]

Thank you for the clarification GD

[Papillon2 in reply to Hidden]

👍👍👍

[rick8637]

Similar treatment 2 yours. Gleason 4+3 in 2018 , PSA 12, lupron for six months and 26 ends of bet. PSA went down to .125 approx and stayed there for 3 yrs. April brought PSA to 4, Sept to12 march to 18 and am now on adt again. I started with furmagon and now on orgovyx pills and hope to see some lowering of PSA and T on a couple months. Ct scan was clear but pet scan pulled up small uptake on femor and rib and lymph node but nothing in the prostate. Sounds like yours might be still in the prostate but you would need more tests to be sure. It is a bummer to be going back again but there are many of us in this boat , new treatments everyday and plenty of success stories. I probably should have started treatment again sooner to choke these bad boys. Get it checked and treated as soon as possible and stay positive.

[caysary in reply to rick8637]

Much appreciate the comment Rick. Best.

[raoulmaher]

ADT I think, looks like cancer increase hope that makes sense kindest Raoul

[caysary in reply to raoulmaher]

Thanks for the comment. PSA came back to 2.2. Also PSMA was clear for now. Perhaps TA's comment above makes sense. I hope so.

[MrG68]

A raise in inflammation, maybe?

It's strange actually, I was having a conversation with someone who had their psa jumping around a bit not so long back. Basically, it was higher than yours and showing a sporadic distribution. He said he wasn't that concerned about it - which was quite unusual I thought.

His reasoning was that he was with the belief that psa rises when you're body fights the cancer to prevent angiogenesis. Or in other words your psa rises to prevent the cancer from spreading. So when he tried various things to combat his PCa, if he saw an immediate rise in psa, he thought it could actually be a good thing. Hence the reason his psa was varying. That had my immediately recalling something I read by the late Nikolas Gonzales where he was using proteolytic enzymes to treat a patients cancer and it started to get sore and inflamed which he noted was a good indicator that the treatment was having an effect since your body uses inflammation to heal.

So, your psa reading would then be a sort of double edged sword. On the one hand, you could view it as a possible indication of increase of the cancer, and on the other hand as an indicator that attacking the cancer could raise inflammation and psa.

Quite an interesting view I thought.

[caysary in reply to MrG68]

Appreciate the comment.

[MrG68 in reply to caysary]

Sorry, forgot to add this reference.

doi.org/10.1002/pros.22512