Need help in understanding PSA level recurrence after treatment.

[Mascouche]

In May 2023 I completed what the doctor hope would be a curative treatment of 38 sessions of radiotherapy accompanied by 2.25 years on Lupron + Zytiga. During that treatment, my PSA fell to < 0.01 and remained there until the end of the treatment.

I had a blood test taken last Friday and it shows that testosterone has begun to come back and along with it my PSA rose to 0.09.

My initial thought was fear and mostly sadness that I would have to go back to ADT so rapidly before I could even fully recover from previously having been on it.

But then I remembered that since I still have bits and pieces of a prostate as I had radiation and not surgery, some level of PSA is to be expected.

So if my lowest PSA reading was <0.01, is it right to say that my Nadir was 0.01 and that I should not considerer that my cancer has returned until my PSA level goes to 2.0 or higher?

I would be sad to go back on ADT immediately just out of fear that my PSA is at 0.09 if that is considered a normal level for someone who still has a prostate following radiation therapy.

Am I too optimistic in thinking that at its present levels, my PSA is not yet an indicator that the treatment failed?

[Tall_Allen]

"So if my lowest PSA reading was <0.01, is it right to say that my Nadir was 0.01 and that I should not considerer that my cancer has returned until my PSA level goes to 2.0 or higher?" Yes.

[Justfor_]

What you stated is correct. You have a long way until 2.0.

[Birdwood]

My situation has similarities to you. That is, RT , 3 year of lupron, undetectable for a reasonable period, several year holiday and now back on lupron. See bio.I could never see the logic in waiting till psa reached 2.0 before getting a PSMA scan. The reason being this scan has high percentage chance of recognising a recurrence at above 1.0 (in fact it can detect lower psa). I waited until 1.6 psa and the Pyl PSMA scan picked up several nodes. Hence the return to lupron. I am planning on anther one when i hit 1.0-1.5. Hope that is a guide.

[mjtct61]

Thank you for this understanding. I finished 43 IMRT treatment and will be on Firmagon for 20mo at end of this year. I have been trying to reason at what point it makes sense to find out if this treatment has been successful. All test prior indicated contained within prostate PSA was 4 now undetectable.

F: Prostate, Left Lateral Base, Core Biopsy

Adenocarcinoma of the Prostate (Grade Group 3)

Gleason Grade 4+ 3 = Score of 7, In 1 of 1 Cores, Involving 70% (Discontinuous) of Needle Core Tissue.

Gleason Pattern 4 Comprises 75% of Tumor.

G: Prostate, Left Lateral Mid, Core Biopsy

Adenocarcinoma of the Prostate (Grade Group 3)

Gleason Grade 4+ 3 = Score of 7, In 1 of 1 Cores, Involving 20% (Discontinuous) of Needle Core Tissue.

Gleason Pattern 4 Comprises 90% of Tumor.

H: Prostate, Left Base, Core Biopsy

Adenocarcinoma of the Prostate (Grade Group 4)

Gleason Grade 4+ 4 = Score of 8, In 1 of 1 Cores, Involving 5% (Discontinuous) of Needle Core Tissue.

[NecessarilySo]

My case was similar. In 2008 I had RT, 38 sessions, Gleason 7, all in prostate. No ADT until over 3 years, PSA began rising above 4 in late 2011. Then metastasis started, I believe spread due to prostate biopsy, tailbone and rectum. Lupron was used intermittently in 2012, 2014, and 2016, each time PSA returned to over 10. Then I skipped Lupron 4 year vacation, PSA rose to 35. Scan 2020 showed questionable metastases so I began quarterly ADT continuous for 3 years now. I'm hoping to control weight, (gained 20 pounds in three years, PSA <0.1), by taking an ADT vacation for 6 months. I used lycopene, heat, and magnets to control/eliminate many suspected metastases...see my bio for details.

[petercraig2]

Hello Mascouche,

I had 35 sessions of abdominal bed radiation probably five years ago now. It gets a little muddied about the effectiveness of radiation as I had already begun using high level Estrogen transdermal patches.

However my PSA quickly decreased in one year to <.008 since March 2019 and over that period have halved the patch concentration. Testosterone dropped and now steady at <.1.

It's been very effective for me with no nasty side effects apart from man boobs which I can live with as a price to pay for QoL.

Hope this helps.

Peter

[Mascouche]

Just wanted to provide an update on my testosterone and psa levels post the end of my "curative intent" treatment which ended in May 2023. Pre-treatment my testosterone was around 18.1 nmol/L

In May 2023 my testosterone was < 0.1 nmol/L and my PSA was 0.01.

In August 2023 my testosterone was 3.3 nmol/L and my PSA was 0.09.

In October 2023 my testosterone was 11.3 nmol/L and my PSA was 0.14.

On Dec 5 2023 my testosterone was 11.9 nmol/L and my PSA was 0.22.

I know that my PSA is still under the 2.0 mark for someone who still has a prostate and had radiation. Nevertheless I think this will keep making me nervous until such a day where hopefully the PSA settles rather than goes up as presently I do not know for certain whether my test results are showing that is par for the course or whether they PSA is progressing too fast.

At least my new oncologist is not like the one I had in August that wanted to put me back on ADT even though my PSA of 0.09 was very far from the 2.0 commonly agreed upon as being a risk of recurrence. My new oncologist says that we'll wait and continue doing tests every 10 weeks and if my PSA ever reaches 1.5, then we'll do a PSMA Pet Scan and if anything shows up past the pelvic area, at that point he'd have a radio-oncologist zap those spots with radiation. Seems more level-headed to me than the approach my previous oncologist wanted to take.