Rising PSA after radiation and ADT

[John347]

Hi All,

I was diagnosed with PCa in April 2022 (Gleason 3+4). My PSA was 28.

I was given a 3 month shot of lupron in June 2022. In August I had 20 sessions of IGRT - Image guided radiation therapy.

These are PSA levels:

0.56 (Sept 2, 2022)

1.6 (Dec 27, 2022)

5.3 (Feb 14, 2023)

Should I be concerned about the rise in my PSA levels?

Does it mean that the radiation treatments have failed?

Should I get a PSMA scan to see if any spread?

Should I go back on lupron to bring down the PSA level?

Could the PSA bounce the result of recovering testosterone?

Appreciate your feedback and advice. Thanks in advance.

John

[Big_Mcc]

John347, very sorry to read your post. Im in a similar position but my doubling time is nothing like yours. Your doubling seems to be approx every 4 weeks which is shocking. Your PSA is well above where it should be.

Should I be concerned about the rise in my PSA levels? Yes

Does it mean that the radiation treatments have failed? It appears so

Should I get a PSMA scan to see if any spread? You should definately get a new scan asap type tba by your oncologist. PSA scan seem appropriate at this stage

Should I go back on lupron to bring down the PSA level? Depends on the scan results but I would think they will suggest lupron + chemo

Could the PSA bounce the result of recovering testosterone? I dont think those values could be psa bounce.

I dont know your situation wrt financing. Singapore is expensive for medical but not USA expensive. You need to address this asap and waste no time. Why has your dr not picked up on your psa values? I just had my second chemo (Docetaxal every 3 weeks)+ ADT 6 monthly injection. My PSA had risen to 6.8 but 18 days after first chemo that was down to 0.5 so dont panick. Equally dont sit and think about it. Hope that helps

[John347 in reply to Big_Mcc]

Thank you Big_Mcc for your reply. I will be meeting my oncologist next week to discuss treatment. I do have government -sponsored insurance, so treatments are quite affordable here.

[Big_Mcc in reply to John347]

Good to hear. The qualityof medicine in Singapore is excellent if you can access it. Wishing you all the best. Contact me anytime if you need someone to chat or bounce your ideas off.

[GP24]

Should I get a PSMA scan to see if any spread? - Yes, with a PSA level that high, the cancer had probably already spread before radiation.

Should I go back on lupron to bring down the PSA level? You should have got at least six months of ADT during and after radiation. Now you can wait for the result of the PSMA scan and go from there.

[John347 in reply to GP24]

Thank you GP24 for your feedback. On hindsight, I should have continued with the ADT. I will probably get another shot of lupron after meeting my oncologist next week.

[GP24 in reply to John347]

With a PSA of 5.3 the PSMA scan will detect tumor spread. Therefore I would get the PSMA scan before starting with Lupron. If the scan detects bone mets, you will have to add e.g. Zytiga to Lupron.

[Tall_Allen]

You should have been on ADT for 26 months (you should also have had a bone scan/CT before radiation). Unfortunately, you stopped early, allowing the more resistant cells to multiply. I think you should talk to your oncologist about going back on an intensified regimen of hormone therapy for 2 years. By "intensified" I mean supplementing Lupron with something like apalutamide.

[Nusch in reply to Tall_Allen]

TA, is 26 month a new duration or a typing error?

[Tall_Allen in reply to Nusch]

26.3 months, to be exact 😀 It's based on this, which is the best info so far:

prostatecancer.news/2022/01...

[Nusch in reply to Tall_Allen]

Thx for the link!

[John347 in reply to Tall_Allen]

Thank you Tall_Allen for your feedback and suggestions. Will discuss with the ancologist next week.

[quietcorner in reply to Tall_Allen]

Question: why would he be on ADT for 26 months, when his Gleason was "only" a 3+4=7? My hubby is a 4+3=7 unfavorable, and he was put on 4 months of ADT. 3 months of ADT prior to treatment, and a final shot during treatment, proton @ a Center of Excellence, and no ADT now he has completed tx.

[Tall_Allen in reply to quietcorner]

There are 3 major components to one's risk level (the Gleason score is just one): PSA, stage, and Gleason score. His PSA was 28, so he is high risk.

[Vynbal]

I don't think that you can infer yet that your treatment has failed. If you had only had RT with no ADT, you would expect your PSA to take 2-3 years to drop to nadir. Your 1 shot (3 month) of Lupron knocked it down to near 0. As it wears off, your PSA will rise to meet the down slope from the radiation. Even so, I would follow TA's advice - your pretreatment PSA of 28 makes you high risk, and implies there might be more, or more aggressive PCa than was found in the biopsy.

[redonthehead in reply to Vynbal]

Hopefully that is the case. If he had no ADT at all, his PSA dropping from 28 to 5.3 at 6 months would be considered good, correct? I think I would following TA's advice but also get a PSMA PET scan for verification it is still contained in the prostate.

[John347 in reply to Vynbal]

Thank you Vynbal. I hope too that the latest PSA of 5.3 does not indicate failure of the treatments. Will follow through on TA's advice.

[tsim]

What did your original MRI show? Any spread around the prostate or nodal involvement? Also, bone scan? Those and a PSMA would be warranted and back on the ADT(they should have never taken you off)

[John347 in reply to tsim]

Thank you tsim. My original MRI and bone scans were inconclusive. It was my decision to stop the ADT due to the side effects which I now regret.

[caysary]

Above 2.0 you qualify for PSMA scan which you should ask for as well as mp3MRI. Also this could be as a result of radiation bounce.

[John347 in reply to caysary]

Thank you for your suggestions, caysary.

[Hidden]

Get back on the lupron ASAP! ❤️🙏

[John347 in reply to Hidden]

Thank you Lulu.

[Hidden in reply to John347]

Good luck John! 🙏

[maggiedrum]

My PSA is doubling but slower than yours. I already had a PSMA PET/CT scan with a full body bone scan. You should be concerned about your PSA rising. I agree 100% with Tall_Allen as to what you should pursue with your oncologist. I'm sorry you are going through this. My oncologist says that he will not order me another PSMA scan (multiple mets found in lymph nodes scattered about). My PSA will be monitored every three months and I will have a regular PET/CT and bone scans each time as well. The plan is to accelerate the scans and testing if the doubling gets worse, which it will. Good luck with all. You have some treatment options which could be very promising so keep at it.

[John347 in reply to maggiedrum]

Thank you Maggiedrum. I will certainly consider getting a PSMA pet scan although it is quite expensive compared to regular pet scan or MRI.

[Papillon2]

Good Luck

[John347]

Thank you Papillon 😊

[John347]

Hi all,

Here's my update after my appointment with the oncologist.

He scheduled me for a PSMA scan about a month from now.

I asked if I could have a lupron shot while waiting for the PSMA scan... his answer was the hormone shot may somehow interfere with the scan results and it's best to wait till after the scan.

He said that if the scan shows just one or two spots of mets, radiation will be used to target those.

If the scan shows more widespread mets, then will have to consider other options.

I know my T level is back because my libido is back to almost pre-treatment level. I hope that's the reason for the 5.3 PSA score.

I will also be having another PSA blood test in about 2 weeks.

I will keep you all updated. Thank you for all your responses.

John