PSA after Radiation

[LeenieC]

Hi all,

This is my first time posting and I wanted to say how grateful I am for this resource.

My husband just finished his 28th session of EBRT yesterday, and the doctor did a PSA test after for a baseline. We just saw this morning that it is at 8.8! We were expecting it to be much lower. Is this normal?

His PSA before radiation was around 12.9, if that helps. He had a 3+3 Gleason, but was considered low intermediate because of the PSA. No hormone treatments as of yet.

We will be talking to his doctor of course, but since it is the holidays we have no idea when, so any input would really help us!

Thanks so much, and wishing you all good health.

[Tall_Allen]

His doctor should not have done a PSA test for 3 months, and it is definely not a baseline. Baseline means his PSA before he started treatment, which was 12.9. When prostate cancer cells are killed by radiation, it releases PSA into his blood, which is picked up by PSA tests. The radiation will continue to kill PCa cells, and his PSA will drift downwards over time, never becoming completely undetactable because he still has a healthy prostate.

[LeenieC in reply to Tall_Allen]

Thank you! This makes us not worry so much. So much for the esteemed Johns Hopkins!

[Tall_Allen in reply to LeenieC]

I'm not impressed by their radiation oncology department.

[Hidden]

My RO took one about a month after completing radiation. And then one three months after that. But, I had been on Lupron for a bit. I've read some studies in which PSA was taken a month after finishing radiation. and then three months after that

They probably just want to make sure it's going down, which it is.

[jazzlover2]

Cancer cells take a while to die after being irradiated. Cancer cells grow and divide/reproduce much more quickly than normal non-cancerous cells, which is why they are so insidious. Radiation damages their DNA, rendering them unable to reproduce. When they reach the end of their thankfully short lifespan, they die without creating other cancer cells, and the tumor dies away cell by cell. All the while the healthy prostate cells and aging cancer cells produce PSA - but the levels go down as the tumor erodes. Basically, it's a process that takes some time, unlike surgery which is more immediate. It's also fairly common to get a PSA bump many months out - my urologist described it as the cancer cells fighting back before completely dying off. Kind of like when you spray a cockroach with Raid and it races around in overdrive for a bit before it flips over. Not a scientific explanation lol!. I had high dose radiation treatment at NYU Winthrop called Cyberknife for a Gleason 3+4 tumor. Had a scary bump about a year out. I have read that 9 months is the average for those who experience bumps. Because your husband continues to have healthy prostate cells that will keep producing PSA - the PSA count will never reach zero.

[LeenieC in reply to jazzlover2]

Wow, thank you SO much for taking the time to give such a wonderful explanation! We are definitely breathing a sigh of relief!

[alperk]

What all those guys said. Yours is close to my experience. You got an early Christmas present. Relax, enjoy the holidays

[Whirlydervish1]

Agree to info above! I am now 18 months post-radiation, PSA almost zero, Doc is happy with status, I am now on 6 month follow ups. Doc says he is watching for nadir in PSA - low point - which may take up to three years. After that, PSA should stay steady at/about nadir level. Mean time, checking every 6 months.

[WilsonPickett]

I had almost the same Gleason. Two years out from SBRT and PSA is .5 and an MRI showing no visible tumor. You have to give it time to work. Breath….

[Teacherdude72]

Just a thought: If the doctor ordered a PSA test right after radiation and called it "baseline" I would find another doctor.

[Mgtd in reply to Teacherdude72]

Not defending either way but sometimes I believe that some doctors or any technical skill may have learned over the years to “over generalize” or to try to “dumb down” their explanations in the interest of time or to reduce patient anxiety. Remember we were not there in the moment.

In any technical skill explanation when talking to a layman under stress, you have to access the situation. You may use a common term like baseline rather the precise definition or reason.

Once again not defending just trying to move the needle from black and white to one of the shades of gray.

[Hidden in reply to Mgtd]

Agree completely. This was most likely just a misunderstanding. Most of us that have been going to a place like that have about a million PSA and Testosterone and every other kind of test going back well before the radiation.

[Teacherdude72 in reply to Mgtd]

Fully agree.