2 point PSA rise after HDR brachytherapy

[curtisbirch]

Hello, Measuring from my lowest PSA after treatment, I am now a full 2 points higher with my latest result of 3.7.

Studies seem to say that a rise of 2+ could be cause for worry--but my radiation oncologist says that this kind of increase doesn't mean anything until I get more PSA results over the coming months. My PSA has to fall to where it was or lower for the 2+ point rise to indicate a bounce rather than a failure. Either way, it is unsettling to watch my PSA, which was in the 1’s, now close to 4

Does anyone have any experience with the signs of PSA bounce vs. the signs of something else? I will be talking to my Dr. again on Monday. But for those who have gone through this, I’d be grateful if you could let me know what your numbers looked like over time. I appreciate it!

PSA 3.7 -- 17 months post treatment

Previous results

PSA 2.5 -- 3 months post treatment

PSA 1.7 -- 6 months post treatment

PSA 2.7 -- 1 year post treatment

PSA 2.2 -- 14 months post treatment

PRE Treatment / DX

PSA 5.3-- pre treatment (3 + 3 Gleason in 5 of 12 cores / 3+ 4 Gleason in 2 of 12 cores)

[Tall_Allen]

Your RO tells you true. Nadir+ 2 is arbitrarily (nothing scientific about it) set as the benchmark for biochemical recurrence, clinical recurrence is quite another thing. You are at prime time for bounces. You probably have some prostatitis going on (do you have a history of see-saw PSAs?). At any rate, wait for at least a couple more progressively elevated PSAs before reacting.

[curtisbirch in reply to Tall_Allen]

Thanks very much — good advice, as always, especially since this was my gut was telling me. The more familiar I’m getting with other people’s PSA results after radiation, the more comfortable I’m getting with the PSA bouncing around. Although I admit it’d be a lot more comfortable if I could get it back into the 1’s again

[curtisbirch]

Appreciate the response. My treatment was a high dose rate /HDR brachy monotherapy. So no ADT or beam in addition. I was looking into cyber knife but the RO I wanted to go with, Dr King, was recommending ADT. A key thing for me was finding the absolute best treatment for my intermediate risk diagnosis that didn’t add more potential side effects and ensured my best quality of life post treatment — being that I’m only 52. That pretty much left me with one choice. I was first diagnosed for monotherapy by Dr Diamanes at UCLA, who pioneered the treatment, and has had very high success rates. Then I ended up going with a student of his who now practices out of Kaiser, DR Wong. He was in my health plan and I would highly recommend him.

[timotur in reply to curtisbirch]

Interesting, I guess your PCa was contained, no ECE or SV, and a relatively low PSA, and thus mono-HDR was appropriate. I had HDR-Brachy under Dr Chang, Demanes's replacement, and I had to go the ADT route because I was Stg 3b with +SV and +LN and PSA of 29 (see profile). It worked really well, PSA now <0.01, but will know the true story when I get off Lupron in August.

[curtisbirch in reply to timotur]

Yes that makes sense, I was at 5.3 PSA with slight concern of ECE based on my mri. That’s why some doctors wanted to add other treatments. However, I was a Gleason 3+3–with Gleason 3+4 found in 2 cores on my second opinion. Dimanes was confident that monotherapy was the best route for me and my gut told me this was the way to go. Especially with side effects being a major concern for me. Glad to hear all is going well for you and let us know how everything looks in August. Thanks again!

[A0007720]

Hey Curtis, I remember reading in literature, as Tall Allen says, that bounces like yours are common. Doctors don't start to worry until there are 3 consecutive increases. You're not there.

[curtisbirch]

Indeed! I appreciate your note and positive reinforcement. My RO says the timing of this particular rise also makes me confident that this is a normal response to the treatment. I’ll keep every one posted on my progress & thanks again!!

[westof]

Hmm... OK here is my history:

My dx was 18 months ago: G9,S3,high PSA 28 and no mets. I just turned 71.

In April I had HDR Brachey and finished 25 days of IMRT in July.

I take Zytiga, prednisone and Lupron and will continue for another year and a half (my MSK MO says that I'm "slightly anemic and treatment is the culprit".

So far, since I started Zytiga in March: PSA steady a 0.014, Testosterone<12 and liver enzymes better than before dx (except for a 2 month spike after starting Zytiga).

Hope this helps,

Best