I was on long term ADT so I’m bouncing a bit now due to my T returning to normal and what remains of my prostate springing back to life. It’s a white knuckled ride for sure.
No SpaceOar, I was patient #1 on the MIRAGE trial randomized to MRidian and the blood test for radiation wasn’t available. I have had no long term side effects from the treatment.
Everyone's situation is different JWS. Dr. Kishan thought since I had some hemorrhoids, it would be a good idea, and would provide less radiation in the rectal area.
So far I have no side effects. Whether that is due to the ViewRay technology, SpaceOar, or both probably cannot be determined.
I know when I was deciding on treatment, Stanford did not want to employ SpaceOar because they felt the evidence based data wasn't there. UCSF would have employed it if I wanted it, and UCLA in my case thought it would add some protection.
As I said, I think it all depends on someone's unique situation, and personal choice.
yes, they gave me Bactrim, but they offered me a choice between that and a floroquinolone like Cipro. The spaceoar was introduced by the transperineal route
Thank you for the response. Although, I am sure there are many men on this site have had Cipro and have never had any problems but Cipro is one of those meds that have been prescribed for years but can have some unpleasant side effects, although rare, why take a chance when there are other antibiotics out there that do the same thing with less side effects.
Just as a heads up - if you're taking finasteride - you can expect a doubling of PSA when you stop taking it. Mine went from 0.1 to a steady 0.2 (+/- 0.04) about a month after I stopped taking it. Finasteride artificially depresses the PSA number (my medical oncologist said on Friday that after 2 years of hanging around 0.2 - that my doubling period seems to be infinity and that I should keep it up. Which was nice to hear.)
Thanks Don. Last time I saw Dr. Kishan 3 months ago, he told me to continue the Avodart.
It is interesting because I am consulting with Dr. Scholz also, and he suggested I should stop the Avodart. I have decided to follow Dr. Kishan in that regard, since Dr. Kishan and UCLA are managing my treatment, so that seemed the best course to follow. In addition, in September Dr. Kishan wants to do another MRI as part of the monitoring on my 1 year anniversary of my SBRT treatment.
I am surprised that after one month of stopping the proscar, you indicated within a month you went from .1 to .2. Most of the literature I have read said it can take up to 6 months. Then again Avodart has double blocking, while proscar is single blocking, so maybe it has something to do with that.
I'm guessing it was about a month - might have been two, or the spacing of the PSA tests vs stopping the Finasteride may have been 2 months.. It wasn't gradual when plotted. What's interesting is the correlation between Testosterone reads and the PSA reads - they seem to track each other rather closely.
John, first, I went off Avodart after being on for twelve years, and my PSA doubled 5 to 10 in short order. Then, a little while later, my PCa became aggressive and my PSA went to 18. I then had 3 three-monthly ADT (Zoladex) injections to lower my testosterone (T) level to make my planned 25 radiation sessions more effective. My T level went from 8.6 nmol/L to <0.4 (from about 90 to 4.5). Concurrently, my PSA went to <0.02. Had the rad treatments in April-May 2020 in the middle of COVID. Now three years later, my T is up to 13.3 (146 and now within my 70-79 age cohort), and my PSA remains stable at 0.06. I will only be concerned if PSA goes to 2.0. I currently monitor with every three months of blood-letting but will be switching to every six months after my next blood-work. After the last rad session I had a further 3 ADT injections which, in hindsight, I would not have had as the Side Effects are most unpleasant and persistent. Keep truckin'
Impressive numbers Monitoring, and wish you continued success.
My PSA on Avodart was 2.7 ng/ml before treatment. I started doing Active Surveillance in 2013 when a small volume 3+3 was found on random biopsy, and started Avodart at that time due to BPH. In 2014 I had another random biopsy when the MRI showed a PIRAD 3, and while the 15 core biopsy only indicated normal prostate tissue, that biopsy induced an infection, which came very close to going septic due to a resistant antibiotic infection, and not utilizing an appropriate antibiotic. Since 2014, I would only do transperineal directed biopsies.
At that time my PSAs under Avodart were running about 2.0 for many years, with MRI periodic monitoring.
When the PSAs started moving up to 2.7 and 2.8, and an MRI upgraded the PIRAD from 3 to 4, I had another transperineal biopsy, both directed and random, which upgraded a 3+3 in the transition zone to a 3+4, I decided it was time for treatment, and decided to have it done at UCLA with SBRT under ViewRay technology with Dr. Kishan. That treatment was completed on September 2022, and so far have not experienced any side effects from the treatment. Based on my low Decipher Score Dr. Kishan did not want to utilize ADT, but wanted me to continue Avodart, I suspect because he didn't want to change any variables at this time.
In September, the one year anniversary of completion of my treatment, I will be having another MRI as part of the monitoring process.
Sorry for responding with too much information, but I wanted to understand other people's experiences after treatment, and how much their PSAs fluctuated during the monitoring process to prepare myself.
John, to fill in some gaps in my first epistle, I was dx with PCa in 2003 and immediately went on AS under Dr. Klotz at Sunnybrook in Toronto. Klotz and I are coming up to 20 years together in August. My GL was 3+3 from 2003 until 2018. I went on Avodart in early 2006 to reduce my BPH and this was successful as my prostate shrunk by about 1/3rd. I stayed on Avodart until Sept 2018 when I went off it and, two months later, my PSA rose from 5.44 to 11.83. This doubling is normal when going off Avodart. In August 2019, PSA was 14.54 and GL had climbed to 4+5. Klotz said "This is not good". I believed him. I was immediately handed off to a radiation oncologist who started me, in Sept. 2019, on a planned 8 three-monthly ADT injection program. I did some research and learned that 6 ADT injections were just as effective as 8. My rad onc agreed to reduce my number to 6! Knowing what I do now, I would have insisted that I quit after 3 injections. AND, unless absolutely necessary, I would not have ANY hormone injections. My SEs are terrible and on-going. I am glad that you elected not to have any hormone injections. But, the ADT treatments did their job by lowering my T level to <0.4 (Canadian measure) or 4.5 (US measure) and this was designed to increase the efficacy of the planned 40 EBRT radiation treatments. Again, I did a lot of my own research and learned that 25 rad sessions were just as effective as 40. Once again, my rad onc agreed. Following the first three hormone injections and the 25 rad treatments, my PSA fell to <0.02 and stayed there for 16 months. Two years after the last rad session and 18 months after the last ADT injection, my PSA rose to 0.04 and now it is 0.06. No problem unless it rises to 2.0. You say you are at 0.5. I don't think it matters how low it goes, more so if it rises again. So, you are in a good place. I assume that you are off Avodart now. If not, this might be worth discussing with Kishan or whoever is looking after you. Keep doing your blood-work. Eat well and exercise. The very best to you.
Very helpful Monitoring. Dr. Klotz is one of the top people in the field. 20 years on active surveillance, that is amazing.
In my situation, Dr. Kishan didn’t see a need for ADT at this time, so I wasn’t given that option. I am still on Avodart, and three months ago he told me to stay on it for the time being. I have an appointment with him next week, so I will ask him again.
I really appreciate your experience. You have provided information to ask Dr. Kishan about.
This chart represents my PSA decline from before treatment to 58 weeks later. I had proton therapy at California Protons. 28 fractions. No ADT. No SpaceOAR, just the balloon. Gleason 7 (3+4). I read somewhere a slow decline in PSA is a good thing. Almost 5 years post treatment. Not sure if I've reached nadir yet.
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Rising psa after Eligard and bicalutamide, in 9 months. What treatment now to stop the psa rise? 
PSA nadir
Recent SBRT w/ADT
PSA after Radiation
