1st PSA Post SBRT + ADT: A Bounce?

[Longrunner]

I had a diagnosis of Gleason 3+4, probable ECE; Decipher .63.

Received 5 Fraction SBRT at MSKCC (Dr. Zelefsky) in early January of this year. 6 months of ADT (Orgovyx) ended May 23, 2023.

At the end of ADT, my PSA was <0.05 and Testosterone was 4.

My first PSA Test was last Wednesday at Penn Medicine in Philly (9 months post RT and 4.5 months post ADT):

Testosterone back: 431.

PSA jumped to 2.069.

I decided to get retested this week at MSKCC to confirm the accuracy of the numbers.

The members of this group have been most helpful to me in the past and I appreciate any advice or experience you can offer as I try to understand these test results and decide on my next steps.

Best regards, David

[Tall_Allen]

Looks great so far! PSA coming back as T returning, as expected. Not a bounce - just expected return.

[Longrunner in reply to Tall_Allen]

Well that is very good news. I thought a 2 point rise above nadir could indicate BCR?

[Tall_Allen in reply to Longrunner]

Give it another 2 years for that.

[Longrunner in reply to Tall_Allen]

I thought that my PSA reading after ADT might have been my nadir. Thank you for helping me understand how to look at my test results!

[Tall_Allen in reply to Longrunner]

It is literally your nadir, but anyone looking at your testosterone coming back would understand why your PSA has risen.

[maley2711 in reply to Longrunner]

Yes, we continually read about nadir + 2 , but now hear to disregard that? Please ask someone on your medical "team", and Google and pubmed are great sources for studies on this question ! Looks like you are being told nadir + 2 only applies if T remains low....but I don't think you would want to give it 2 years as PSA rose to 50????

[Longrunner in reply to maley2711]

The NCCN Guidelines for Radiation Recurrence reference the "Phoenix Consensus" that a PSA increase by 2 ng/ml or more above the nadir is the definition of PSA recurrence after EBRT. I am retesting at MSK to make sure the same assay is used to compare my PSAs. After that I will follow up to make sure I understand 'where I stand' and the criteria being used to evaluate my PSA going forward.

[maley2711]

Is Dr. Zelefsky unwilling to discuss this with you?

[Longrunner in reply to maley2711]

Dr. Zelefsky has left MSKCC to head up a program at NYU. I have been referred to Dr. McBride at MSK and will follow up with him after I receive my results from tomorrow's blood test. More 'news' to follow . . . Thanks very much for your replies!

[Mike404]

I believe the 2 point rise above nadir is in the absence of ADT. No testosterone immediately and dramatically lowers PSA. So I’m not sure how they look at this with ADT, as it’s a lower nadir from that. I’m also about a year out, six months from end of ADT, and my PSA was at 0.08. My testosterone is still only 220 though. I’ll be interested to hear what MSK has to say.

[Longrunner]

Is your PSA currently at 0.08?

I double checked and the 2 point rise above nadir is the standard definition for PSA recurrence after EBRT "with or without HT".

[Seasid]

Did you have parametric MRI scans before and what time after your sbrt? Did you have psma pet scans and when?

What was your PSA before starting ADT and before radiation? What was your Gleason score?

[Longrunner in reply to Seasid]

Hello Seasid.

I had 2 MRI scans before SBRT and HT. No MRI after SBRT. I have not had a PSMA Scan.

My last PSA before ADT and radiation was 3.22. GL 3+4.

[Seasid in reply to Longrunner]

Some people are getting post sbrt parametric MRI and even psma pet scans before and a year after sbrt. I know someone who did that in NYC MSKCC he was oligometastatic. You may don't need it if your cancer is not aggressive. Some people (as a part of a clinical trial) could get even an MRI guided biopsy two years after the radiation procedure.

I am not a doctor but maybe you could ask your doctor about MRI if you have a concern about the cancer repopulating your prostate as MRI is not invasive but still better to avoid if you don't really need it. Best of luck.

[Longrunner in reply to Seasid]

Thanks much Seasid. Still 'early' post treatment. Hopefully my PSA will behave and a PSMA pet scan or MRI won't be required.

[PSAed]

Hi Longrunner, can I ask , how are your PSA readings now?