Update: PSA after IMRT

[Smarks42]

After my 40 treatments, I wanted to get off the bicalutamide I had been on for 2 months. My breasts had not only gotten enlarged but they had also become quite painful, and the Tamoxifen my RO had put me on did not help with this. He then ordered an early PSA test, and when it came back at just .12, he was okay with my getting off the bicalutamide. Now it is 3 months later, and he ordered another round of PSA and testosterone tests. PSA is now .24, while T dropped a bit from 297 to 273. I am hoping that because the .12 was such a low number post-treatment, the rise to .24 still leaves me at a low enough level to not be worrisome. What do you think? Let me add that my overall experience with treatment has been quite good. I've had no significant urinary or bowel problems. My biggest concern was that my libido had totally disappeared. At 81, sex had still been an enjoyable part of my life, so I was disappointed that it was now feeling so alien and undoable. Then recently, my sexual interest suddenly reawakened and my erections reappeared. I was delighted! My RO had told me a while back that I have the T of a much younger man, so maybe that is what made the difference. And maybe I was simply being too impatient, because I'm well aware that 4 months post-treatment is often too soon to draw final conclusions.

[Justfor_]

Silly docs operate on a "one size fits all" principle. I am also very sensitive to Bicalutamide as I guess you are. My latest dosage is one 50 mg tablet every 10 days. Yes, every TEN days. Yet, I have tried 3 times to reduce my Tamoxifen dosage and within I week I felt tendernes in my chest. Find the dosage that will keep your PSA stable with zero SE. If interested, take a look at my "Bicalutamide maneuvers" thread.

[Smarks42 in reply to Justfor_]

Very interesting that such a small dose can nevertheless keep your PSA within your desired range, especially for a drug-sensitive guy like me. I looked at your "maneuvers" thread, and although I couldn't understand the mathy specifics, I think I got the gist of what you're looking at. By the way, after two months off of bicalutamide, my breasts are a little less swollen, and the pain has lessened a little as well. How much Tamoxifen did you/are you taking? I was taking 100 mg. I had no SEs from that one, but I quit it after a couple of weeks when I decided it wasn't doing anything for me. I considered trying a 200 mg dosage but decided against it, as my driving instinct is to avoid pharmaceuticals whenever I can. I've also considered my RO's offer to do a light radiation treatment to my breasts, but I read something somthing that dissuaded me from that approach. Any thoughts?

[Justfor_ in reply to Smarks42]

I take 10 mg/day. Half of this proved too little. You probably have confused your numbers. 100 and 200 mg are too much. Also, you shouldn't have stopped Tamoxifen at the same time with Bicalutamide. It takes approx 1.5 months for Bicalutamide to clean out from your blood. All this time, gynaekomastia advanced.

[maley2711 in reply to Justfor_]

Link to that?

[Tall_Allen]

It is way to early to read anything into your PSA.

[NotDFL]

Moreover, you can expect your PSA to go up some and perhaps bounce around. Hopefully it will stay below 2.

[Smarks42 in reply to NotDFL]

I've read about PSA bounces after RT, but it's not clear to me whether or not the bounces stop at some point. Perhaps never. I do know that I took a half hour bike ride a day or two before my 2nd post-treatment PSA test, and we had sex once within that two-day period. Could either of those have influenced the .12 rise in my PSA? (But maybe Tall Allen is right: It's too soon for me to draw any conclusion about PSA.) One more question here: Now that my RT is done, is there anything wrong with bike riding?

[NotDFL]

Bike riding is excellent of course. It is often mentioned though that it can rise your PSA. Not sure if there are any rigorous studies about this, but I would refrain from mounting your locomotive for two days prior to a test.

[Bethpage]

I'm really sorry that you had such a rough time with bical. My husband started on 2.5 years of bical 50 mg in February of 2019. At 3 months in, he developed the breast tenderness. He's skinny so it bothered him. T_A recommended 10 mg of Tamoxifen, promising no reversal in the gynecomastia. My husband got lucky in that the gynecomastia did reverse the gynecomastia entirely. He did the extra 2 years + 3 months symptom-free except for mild hot flashes. I don't know if this is right, but his uro says that bical has almost no effect on T. I hope you can hang in.

[Smarks42 in reply to Bethpage]

Thank you Betpage, and I’m glad your husband tolerated treatment so nicely.

[Smarks42]

j-o-h-n, yes, and if my name was Jack and my everloving was willing, I could then be a jack in the box.

[j-o-h-n]

Got to Hand ✋ ✋🏻 it to you "Thinking inside the box".......

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/01/2023 10:33 PM DST