Post Salvage Rad PSA expectations

[Wicker2]

My details are in my bio but I had RARP in Apr 23 and the post op path report was GL 3+4 with pos margin and a focal ECE but 8 nodes and seminal ves were good. My PSA from 2, 3 and 6 months was .08. .07, .09 resp then rose to .14 at 9 months. Referred to Rad Onc and had 25 hypofractions of IMRT (no ADT) ending mid Aug 24. Just had my 6 month PSA and it is .08 which concerns me since I was expecting <.03. I know .08 is low but is it a sign that I am in for a continuous rise? Is it a common occurrence?

I have a follow up with my Rad Onc next week and just checked my PSA on the Medical portal instead of waiting for the Dr to tell me.

Thanks for any experiences that you might have to share.

[NanoMRI]

I had my salvage RT to prostate bed at 0.11. My first post RT uPSA was 0.075 - we knew we missed. I tested every subsequent month and tracked slow steady rise; same as post my RP.

As to question of being common, seems so as data for Dx, need for ADT, CR and death rate are not improving. All the best!

[IKNY]

I was told to expect a bump in PSA after consolidation radiation.

It was explained to me that the cancer cells sometimes express PSA as they die.

I’m my case, there was no PSA bump, though I’ve been on ADT Lupron/Nubeqa and have had negative PSA for one year.

Although I had a RALP, it unfortunately had spread to local lymph’s and one para aortic node.

So far so good, I would definitely ask questions immediately and if you have metastasized, you need to be on some form of ADT.

[Tall_Allen]

In the world of radiation therapy, it can take years for the PSA to go down (it took me 3 ½ years). It is way too soon to react.

[AlmostnoHope in reply to Tall_Allen]

Great feedback. Listen to this.

[ron_bucher in reply to Tall_Allen]

Was that after salvage radiation?

[Tall_Allen in reply to ron_bucher]

It doesn't matter if there is no ADT. It takes a while for zombie cells to give up the ghost.

[MateoBeach]

Did your salvage RT include the pelvic lymph node fields? I understand that is the current SOC for SRT. Ask your RO if not sure. The PSA is not a worry at this point.

[Wicker2 in reply to MateoBeach]

I'm not sure, I will ask this week. Thx!

[ron_bucher]

Every case is different. I was fortunate with 7.5 years of undetectable PSA after my salvage radiation without ADT.

Remember the trajectory of PSA is usually much more important than any absolute value.

I've rarely seen or heard of a Gleason being lower on the RP pathology report than on the biopsy. Have you considered getting a PSMA scan?

[Wicker2 in reply to ron_bucher]

The biopsy had 3 cores 4+4 but only 1 or 2 mm so, when the post op pathology was done the grade 4 was only 12-15% of the tumour.