Rising PSA 18 months post LD Brachytherapy

[blkman60]

Dear Brothers, friends, and caretakers,

I apologize in advance for posting in the wrong forum. It's been a while since I've been here and I'm not sure where to post...

I had low dose brachytherapy radiation (permanent seed) implants over 18 months ago and the lowest my initial post brachy PSA was .6 and it was .7 for about 6 months now it went up to 1.1.

I stop eating meat and my alcohol consumption is a beer or two over the weekend at MOST.

However lately I've been smoking marijuana over the weekend. Not much, for example, one joint will last two and sometimes 3 weeks (it doesn't take much). My sugar consumption might have increased a little but it's not been much. I'm concerned and made an appointment with my doctor and I'd like to query this all-knowing forum to find out if someone had the same experience and what they've done to get their PSA back under 1 (I hope that's possible). I'm also concerned because my PSA is on an upward climb and I am under the impression (as my understanding is) that if your PSA keeps rising that this potentially signals biochemical failure/relapse.

It now has been 18 months and I'm wondering how concerned I should be given this upward trend. It doesn't look like a PSA bounce as insofar the PSA has been steadily rising upward. Though it is now 1.1. How concerned should I be?

I'm meeting with my Dr. this Monday and would like to get your recommendations as to what I should I ask in terms of treatments and how concerned should I be because honestly, I am scared. I am very anguished by this result. Prior to my surgery, I was diagnosed with an intermediate Gleason of 3+4, and PSA was hovering around 7 and the cancer was localized and had not broken out of the capsule.

I still go the bathroom frequently (average 3 times at night) and I've never gotten back to a consistent continuous stream of urine. I feel like I'm "pissing like a sea serpent!!" Joking aside, I re-started taking Flomax again for the past 6 days and I noticed lately that when I don't take it, it's bad.

Looking forward to your feedback and sending you much love and good vibes!

[timotur]

I believe after Brachy radiation, BCR = nadir-PSA + 2.0, so your benchmark would be 2.6 along with three consecutive rises before considered as such. I would take another scheduled PSA test before being alarmed. If BCR is indicated, the next step would most likely be a PSMA scan to look for LN involvement and if so, then treat with pelvic radiation (IMRT) with ADT.

[blkman60 in reply to timotur]

Thank you timotur. This is useful to know. Others have recommended ADT and I will discuss with my MD on Monday. How early should I take this other PSA test?

[timotur in reply to blkman60]

I would just take the next PSA test as "scheduled" to establish a trend. It appears you may have been doing so every six months. Increasing the frequency of tests would probably cause more anxiety.

[blkman60 in reply to timotur]

Makes sense Timotur. I agree, but on the flip side of that, wether doing this test every 3 months or six months, my anxiety is still here, like the big bad Gorilla silently staring at you, you try to ignore it, brush it off, but it massive size will not let you know forget him no matter how much you convince yourself otherwise.

[Tall_Allen]

You are doing fine. Your RO should have told you to expect these kinds of "bounces" in PSA. Remember, you still have a prostate with many irritated, yet healthy, cells that can still put out PSA. In fact, there is a known association between such bounces and complete cures. I know it is nerve-wracking . I've had several such bounces myself before my PSA settled down. It took me about 3-4 years before I reached my final nadir (0.1). Read this, I hope it helps you feel less anxious:

pcnrv.blogspot.com/2018/03/...

[blkman60 in reply to Tall_Allen]

You are the man, Tall_Allen! Thank you for alleviating my concerns. Nerve-wracking pretty much sums it up. How are you these days? Are you still in LA? What are your thoughts of Garcetti's decision to trasition our city to phase 2?

[Tall_Allen in reply to blkman60]

I don't live in LA city, so I haven't really followed. I miss Starbucks.

[blkman60 in reply to Tall_Allen]

I miss grand central market and DLA food row. My wife and I are major foodies. I can't wait for things to go back to normal. Are you still in Southern California?

[Tall_Allen in reply to blkman60]

I live in West Hollywood- part of LA county, but not the city.

[blkman60 in reply to Tall_Allen]

Close enough! We are in Koreatown in the middle of Wilshire & 6th street. Matter of fact, my wife works closely with counselman Mitch O'Farrell. We used to live in West Hollywood right by the grove. We are now just a 2 miles away if that. We should all get together for coffee when this thing goes away, hopefully in the foreseeable future.

[Tall_Allen in reply to blkman60]

I'd like that. Let's hope it's soon.

[Buddy_Blank]

I had LDR brachy too. I also had a few bounces, and they scared the heck out of me! People assured me they were normal, and some told me "the bounce is your friend," while pointing me studies that showed that to be the case. Here is one such study: ncbi.nlm.nih.gov/pmc/articl...

Hang in there!

[blkman60 in reply to Buddy_Blank]

That's comforting to hear. When did you get LDR brachy and what was your initial diagnosis?

Thank you Buddy_Blank!

[Buddy_Blank in reply to blkman60]

Here's my PSAs:

4.76 5/12

4.23 8/12

3.98 10/12

4.9 2/13

2.9 6/13

2.7 11/13

1.31 3/14

1.07 7/14

0.69 10/14

1.6 3/15 <- bounce

2.0 6/15 <- bounce

0.64 8/15

0.68 4/16

0.16 11/16

0.12 6/17

0.12 6/18

0.04 6/19

As you can see, it took five years to reach my nadir.

[Buddy_Blank]

I had it done in 2013. I don't have my PSAs handy, but I do recall I bounced upward 2x.

Here's my biopsy:

Biopsy right prostate: Benign tissue

Biopsy left prostate: Prostatic adencarcinoma, Gleason score 7 (4+3), tumor involves 2 of 10 cores & 5% of total tissue sampled, Stage T1c, positive for PNI

TRUS measured prostate volume 19.36 cc - Stage T1c

66 Pd-103 seeds implanted 3/13

[blkman60 in reply to Buddy_Blank]

Thanks Buddy_Blank! This is very reassuring. I find your diagnosis interesting in comparison to mine. My gleason was also 7 but 3+4. Yet although my gleason score was not as aggressive as yours, both sides of my prostate were infected (I'd have to dig through my doctor's notes to be more specific) and my diagnosis was that of T2a (or b, I have to check again) at that time these details were obfuscated by the sordid intermediate diagnosis, but I appreciate your level of details! Now I find myself wondering with more involvement in my prostate and intermediate cancer wether I would have been better off removing my entire prostate given that both prostate cores were infected.

[Hidden]

Did you have these urination problems prior to the brachytherapy? Keep your urologist informed of this issue. I wonder if you will need TURP surgery at some point to improve flow. I had that surgery for enlarged prostate 10 years prior to prostate cancer diagnosis. My only regret was that I didn't have it done sooner. There's also a new, less invasive procedure called rezum for this kind of problem. Good luck with your recovery.