My 22 month psa after radiation treatment (SBRT) is 1.25. What should my nadir be? Less than 0.5?

[mike2344]

I just had my PSA test yesterday (8/21/20) and the number is 1.25 as compared to 1.69 on 3/19/20. I was diagnosed with PC in July 2018 with Greason score of 7 (4 + 3). I had radiation treatment (SBRT) at UCLA in October 2018. I am 70 years old.

I have enclosed my historical PSA from 2012. Please note that I had a couple of PSA Bounces from 10/19/19 to 2/18/20. I am guessing that my PSA Bounce was caused by prostatitis which seemed to go away after I took Antibiotic in June'20.

PSA 3/19/20 (1.69), 2/18/20 (`1.84), 2/3/20 (2.46), 1/28/20 (4.06),11/26/19 (1.68), 10/19/19 (2.03), 7/19/19 (1.91), 4/16/19 (2.58), 1/21/19 (3.8), 8/29/18 (7.84), 7/9/18 ( 7.82) 5/15/18 (7.15) 10/16/17 (6.07) 3/3/15 (4.06) 9/24/14 (4.69) 10/18/13 (3.79) 3/22/12 (3.97),

mail.google.com/mail/ca/u/0...

Should I be concerned about my psa has not gone under 1 after almost 2 years?

Mike

[Tall_Allen]

You are getting way too many PSA tests. I'd guess you have prostatitis, which makes your PSA bounce around like crazy. Antibiotics don't really work - expect PSA to bounce back. At this point, one every 3 months is more than adequate- anything more will drive you crazy. Time to nadir varies a great deal from individual to individual. It took me 4 years. Long time to reach nadir is prognostic for success. You're in it for the long haul.

prostatecancer.news/2018/03...

[mike2344 in reply to Tall_Allen]

Thanks again for your response. I plan to check my next psa in 3 months. Mike

[Tall_Allen in reply to mike2344]

Are you with Dr Kishan at UCLA?

[curtisbirch in reply to mike2344]

You are in a very good place after only 2 years. Your next PSA at this point should be no sooner than 5-6 months from your last. There is nothing of concern here — you’ve had healthy bounces in PSA and now show a very promising downward trend. I am passing along this advice from Dr King, who invented SBRT.

[mike2344 in reply to curtisbirch]

Thanks for your response. Mike

[Stevecavill]

my psa dropped to 0.01, but I was also on ADT. Have you had any other treatment. Where was the SBRT targeted?

[mike2344 in reply to Stevecavill]

Thanks for your response. I never have any other treatment or ADT. Mike

[Stevecavill in reply to mike2344]

It’s unusual to do radiation without ADT, because the Joint effect is amplified. So a psa above 1 doesn’t surprise me. Has your doctor recommended adt at all? That would make sense to me.

[curtisbirch in reply to Stevecavill]

HDR monotherapy, whether brachy or SBRT, is not only common for Intermediate risk pCa but also highly effective.

[mike2344 in reply to Stevecavill]

My doctor let me decide whether or not to take ADT. The potential side effects scared me so I decided not too. I might have taken a 4 or 6 month ADT if I knew at the time that the side effects are very mild if we take ADT for a short time.

Thanks for your response.

Mike

[curtisbirch in reply to mike2344]

I could see how you could seriously consider hormones when you’re on the fence of intermediate high risk. In fact, I probably would have gone with SBRT with Dr King. But he wanted me to do 6 months of hormones in tandem with SBRT because some doctors read my biopsy and 3t MRI as borderline high risk intermediate. I had a 7 of 12 cores positive 3+3. However, a second opinion on the biopsy revealed some 3+4 in two cores as well as perinueral (sp ? ) invasion. My 3t mri showed possible ECE but I got a second opinion on that, which attributed this concern to camera shake. Dr Dimanes at UCLA diagnosed me as a prime candidate for HDR brachy monotherapy. His diagnosis via ultrasound indicated that I had localized PcA and that monotherapy with HDR brachy showed the best 10 year results for my diagnosis. I was always looking for the best quality of life solution — bring 50 yrs old — so there was no question in my mind it was better to just do one treatment and deal with only one set of potential side effects.

[mike2344 in reply to curtisbirch]

Thanks for your response. Mike

[doc1947g]

I had Lupron Depot 22.5mg/12weeks on May 31st 2020 (next one on August 24th 2020) and VMAT hypofractionnated RT 3Gy X 20 days, finished July 7th 2020. Testing done on July 29th 2020: APS = 0.18 and testosterone = 0.2 nMol/L. My RO was happy with this results and my GP told me that she was surprised 😳 by that "fantastic" results.

But everybody react differently so you "nadir" may be higher.

[mike2344 in reply to doc1947g]

Thanks for your response. Mike

[billy1950]

Hi Mike,

I had radiation in 2004-2005. Since then my PSA has been going up and down. Around 1.4 now...My RO says my nadir at .6...Have you asked your RO what your nadir is?

He tells me that it has to go above 2 above my nadir to be concerned. I never had 𝖠𝖣𝖳 and no one has suggested that i need it. My original diagnosis was PSA at 6.9 with a gleason of 6. Hopefully the initial radiation in 2004-5, (40 sessions) has done the job...However, since the prostate is still there (radiated), he says that i will continue to have some PSA ...

Erections are strange i have them but that’s about it, nothing much comes out!

How are you doing?

[mike2344 in reply to billy1950]

Aloha Billy,

Thanks for sharing. I have not found my nadir yet because it is still going down. I am not sure how much radiation affects the erections.

Mike

[JuliesHusband in reply to mike2344]

A bit late to the conversation, but radiation may or may not ever affect erections. It can cause the supply blood vessels to age prematurely. Or it may not. I chose radiation over surgery as I was 74 years old and decided that the maybe of recovery after surgery was not as good as at least three to five years of sexual enjoyment after radiation and ADT.

[billy1950]

take a look at my history of PSA...looks similar to yours. I had radiation in 2004-2005 and my psa is bouncing too. My last two was 1.45 (in the summer) and recently 1.69. My nadir is .6....both uro and onc. tell me that it is ok for now...They are waiting for it to go 2. ng above nadir...That would be PSA of 2.6...They are going by the “phoenix decision” for what i can understand...

[mike2344 in reply to billy1950]

Thanks for your response.

[doc1947g]

Here is a list of my PSA:

* PSA μg/L = 4.23 (2001/07/18), 2.2 (2002/07/23), 1.8 (2006/07/04), 2.2 (2008/09/22), 2.4 (2009/05/20), 2.05 (2011/08/26), 2.25 (2012/08/13), 2.05 (2013/08/06), 2.77 (2014/07/28), 3.84 (2015/07/06), 1.97 (2016/06/30), 3.89 (2017/06/13),

Pre-ADT

6.8 (2019/09/10), 11.7 (2019/10/28), 13.7 (2020/01/08), 16.7 (2020/03/02), 20.4 (2020/04/06),

Per-ADT

1.76 (2020/05/04), 8.58(2020/05/27), 0.18(2020/07/29)

VMAT-RT = 2020/06/08 to 2020/07/07 60 Gy

ADT 2020-05-29 + 2020-08-24 ended 2020/11/16

Post ADT

0.03(2020/09/15), 0.01(2020/12/15)

A list of my Testosterone Levels:

Per ADT

10.30nmol/L - 294.19ng/dL (2020/05/04), 15.2nmol/L - 438.04ng/dL (2020/05/27), < 0.2nmol/L - < 5.768ng/dL(2020/07/29).

Post-ADT

< 0.2nmol/L or < 5.7636887608069ng/dL(2020/09/15), 0.3nmol/L or 8.6526 ng/dL (2020/12/15).

I still do not know if 0.01 is my nadir or just an ADT response.