PSA 8 months after EBRT

[electronics-guy]

I need some reassurance. I tend to worry a little bit so please let me know if the following is or could be somewhat normal. As per my history, I had 4+3 per Dr. Epstein, had Pylarify with no mets, seed implant LD brachytherapy in July 2023, EBRT 28 treatments finishing first of Oct 2023. RO said ADT not necessary due to double radiation. Highest pretreatment PSA was 4.4.

I go to the PCP for a few other issues and he runs a PSA each time he does a blood work. My PSA/Testosterone end of Oct 2023 was 2.80/238; Dec 2023 it was 1.76/275; and this week, June 4th 2024 it was 1.74/268, basically no change in 5 months. I see my RO next month, first of July.

I’m concerned that there has been NO change in the last 5 months. I was expecting at least a little less in 5 months. Is this something to be concerned about or just the way PSA can run after radiation, which as of this week, has been 8 full months. I want to be able to ask the RO the correct questions when I go. MANY thanks for any information (or reassurance) you can give me.

[Derf4223]

I suggest you put your age in your profile

[electronics-guy in reply to Derf4223]

Good idea. I'm 70.

[Tall_Allen]

Radiation takes patience. It took me about 4 years to achieve my nadir with bounces along the way.

[electronics-guy in reply to Tall_Allen]

Thanks so much for your response. I actually feel the reduction of the stress with that answer coming from you!

[maley2711 in reply to Tall_Allen]

So, the official method for determining the actual nadir?

[Mgtd in reply to maley2711]

I assume you are asking the “official method” to determine when the Nadir occurs?

Here is my laymen’s answer to that. Time, patience and PSA tests to look back and see when the last three PSA tests showed a consistent rise. So looking back you find out when the Nadir occurred. No way to project ahead.

[maley2711 in reply to Mgtd]

That seems to be one method? But to mean a lot to me, I guess I'll look around for something more official on the question...maybe ask RO tomorrow.

[Mgtd in reply to maley2711]

Be curious what the RO says.

[chrisNYC in reply to Tall_Allen]

TA-

i had SBRT with 3 months of pre radiation ADT in 4/2022

my PSA was 1.0 six months later, then .5, then .7 and then .8. RO is a bit concerned with the rise.

i am being retested on PSA and testosterone (to see if they are rising in conjunction).. if psa goes up again and T does not.. i am going to be scheduled for a battery of scans.

how bad were your "bounces"?

[Tall_Allen in reply to chrisNYC]

That's nothing. Read this:

prostatecancer.news/2018/03...

[conbio in reply to Tall_Allen]

Thanks for posting this TA

[chrisNYC in reply to Tall_Allen]

many thanks for this, it provides some anxiety relief.

however, i had my PSA retested yesterday and it is now 1.03

8/22 = 1.02

4/23= .5

12/23= .7

3/24= .8

6/24= 1.03

pre-SBRT in 3/22 i hit a PSA of 12

[Tall_Allen in reply to chrisNYC]

Biochemical recurrence is nadir+2, so that would be 2.5 for you. And a biochemical recurrence doesn't necessarily mean a clinical recurrence.

[WilsonPickett in reply to Tall_Allen]

Boy that’s good to know Tall Allen. 2.5 years post SBRT, I had a bounce yesterday from .52 to .95 and was kind of freaking out. Glad you reminded me about the bounces.

[EdinBmore]

I don't have a MD but your numbers sound good. My PSA dropped from 23 to 0.04; lowest was 0.02. It's been 7 yrs since treatment stopped. Also had IMRT and ADT.

Definitely ask your questions! Get second opinions. Understand your options.

Make sure you exercise ...exercise all parts. Keep the blood flowing "down below." Monitor T. Took yr and half for mine to return.

Good luck to you.

EdinBaltimore

[PT49]

The prostate journey is really a crap shoot. I'm new to this journey myself. I was 73 at diagnosis with a Gleason 7 (4+3) in 4 out of 12 cores--up to 45%. PSA was 3.9 at diagnosis and 5.1 at the beginning of treatment two months later. I have spent a lot of time on this website and others and what I have distilled from all of the discussions and research is this: There are a lot of doctors that don't seem to be aware of standard of care for the best treatment options. My urologist, who is also a very successful surgeon, advised me towards radiation. My RO advised me to take the 6 month Lupron shot beginning a month before radiation. I had SBRT (5 sessions) that were so easy I didn't even know I had them. My Lupron journey, on the other hand, has been a living hell but I am glad I did it. However, I wouldn't want to go down that road again. In July it will be a year and I am still having side effects from it. However, my PSA has been at 0.04 for the past 8 months and I attribute that to the ADT. Gleason 7 (4+3) is unfavorable and from my research the SOC with radiation , as the main treatment, is always (with very few exceptions) radiation plus ADT. If I was in your shoes I would get a second opinion regarding not taking ADT. Also, see if there is any benefit to taking it now.

[doc1947g]

I was 72 years young with a PSA =21.4 μg/L and G(4+3=7)Grade 4. Put on VMAT-RT 3Gy X 20 fx = 60Gy and ADT(Lupron Depot 45mg/24weeks).

Now at 77 years young, my PSA = 0.01 μg/L.

No SE.

🐒🐵🙊🙉🙈

[Surfer33 in reply to doc1947g]

Hi Doc, just curious, PSA over 20 puts you in a high risk group, so I'm told. Recommendation was for only 6 months ADT? Thanks

[doc1947g in reply to Surfer33]

After 6 months, my response was great, so they checked my PSA regularly and my PSA is still 0.01 μg/L . So I am very lucky because I cannot exercise at all.

[Surfer33 in reply to doc1947g]

After 6 months , PSA reading was 0.01? Just curious after 5 months ADT and couple weeks post IRMT my PSA .58 down from 27.

[cscmetsfacil]

Howdy! In your initial note you mentioned concern that you were seeing no change after 6 months. But the the numbers you reported shows that your PSA went from 2.8 to 1.76. That is a change of more than 1 point, or around 33%, in the right direction. You mention seeing a PCP who has you PSA checked. If you see them less than every 3 months you might want to have your PSA checked at least that regularly so you can see the trend. Because you have had no ADT you are not going to see a drop to the super-low PSA readings that you hear others talk about. I have aggressive PCa and my PSA came back after my primary treatment of HDRT Brachy and 25 EBRT sessions. A PSA about10 months after primary treatment showed a couple of faint uptakes in the pelvic bed. Luckily, I had docs who knew that EBRT kills the cells more slowly and the uptake could be residual cells. That turned out to be correct. Subsequent PSMA PET scans have found no sign of PCa in the pelvic bed which indicates that primary treatment was effective, if a bit too late to stop spread in my case. So you may very well be just fine. As others have said, keep talking to your doctors, don't be shy about asking questions. Sounds like you are doing well.