PSA after SBRT for Oligometastatic

[billd50]

I recently had SBRT (5x9gray radiation treatments) for a single spot on L7. The spot was found by a PET/PSMA scan. PSA at the time of the scan was 1.1. (Dec 2022) Originally treated for High risk PC with 5x9 and 1x10 Gleason with 2yr Lupron, Radiation and Chemo (Docetaxel). Treatment ran from Dec 2015 -Dec 17. PSA Nadir was .6-.7 after everything settled down.(2020)

So my psa at 4 weeks after SBRT (Feb 23)went up to 1.7. Is it normal for psa to go up after SBRT to the spine at the 4 week point? When should I see it go down? My Rad Onc may not have set my expectations correctly. Thoughts?

[Tall_Allen]

You should talk to your MO about adding Lupron+Zytiga.

[Teacherdude72]

Ok, so I am still learning after just 8 years of pca. What do you mean when you stated "High risk PC with 5x9 and 1x10 Gleason"?

[billd50 in reply to Teacherdude72]

5 biopsy cores were Gleason score 9 (5+4) and 1 biopsy core was Gleason score 10 (5+5).

This is classified as very high risk prostate cancer.

[Teacherdude72 in reply to billd50]

I just questioned your 5X9 & 1X10 way of saying.10 of my cores were 4+5 for a Gleason of 9. Also very High Risk.

Has image guided rt and two sessions of HDR Brachy. 7 yrs ago, now on Nubeqa/Lupron.

[billd50 in reply to Teacherdude72]

You sound like you're in my boat. I was diagnosed 7 1/2 years ago. Received 2 years of Lupron, 45 rad sessions and 6 rounds of chemo (docetoxel). I recently received SBRT to 1 lesion that popped up on T7. So technically diagnosed as Oligometastatic. Good luck to all of us.

[john4803]

I agree with TA, you need to be on Lupron, plus, something else. I was determined Oligometastatic after going off Lupron for 1.5 yrs, when PSA went from <0.1 to 0.4. Had T-11 Cyberknifed & thought that was the end of it. Instead increased to 7.3 with numerous lesions. Then went back on Lupron w/Erleada but only lasted 6 months. Have qualified for a trial & had first LU177 infusion, otherwise, I would have had chemo.

You may have millions of cancer cells that don't express any visible PSMA yet & will eventually get together & start to party & your bones may be on their dinner menu! 🥵