PSA Trend

[caysary]

Hello gentlemen,

Can anyone tell me if this trend is normal or concerning. Please read my profile before reply. I am going into my 3rd year after SBRT. Nadir may have not been reached yet.

[Justfor_]

I had to guess the months, but they should be close enough.

My take: With a PSADT of ~3.3 years you shouldn't be concerned.

Nadir was in the second quarter of 2023 IMO.

Caysary

[caysary in reply to Justfor_]

Thank you Just for but how do you know nadir is reached when it can take up to 4-5 years for that.

[Justfor_ in reply to caysary]

To start with, I don't "know" what the future may bring. I am just offering you my best estimate based on the time series at hand. To take it a bit further, nadir is a mathematical quality/property, not a temporal one. The graph that you posted depicts a curve that went through a minimum. Is this the minimum minimorum, aka the nadir or not? No one, serious enough, can tell you, sorry.

[caysary in reply to Justfor_]

Appreciate that. here's a profile of a 3+4 no ADT that my give clues as to why some are different at nadir:

Nov 2017 Treatment is done 5 sessions over 2 weeks Original PSA 13

PSA Test May 2018 5.0 6 Month

Nov 2018 2.1 12 Month

Nov 2019 3.1 The is the PSA bounce at 18-24 months

Nov 2020 2.0 36 Month

Nov 2021 .46 48 Months

Nov 2022 .16 60 months

Nov 2023 .12 72 months

Apr 2024 .07 78 months

[SeosamhM in reply to caysary]

I agree with both Justfor_ but understand your question, caysary. I agree with Justfor_ because time to nadir is simply a statistical construct and cannot be applied specifically to an individual. But your query is a valid one. I will give you a perspective from my own aPCa-bias on these types of questions.

At least one paper (see: ncbi.nlm.nih.gov/pmc/articl... gives the median time to nadir with men with similar treatment to be 44.8 months, but the range was large - between 0.40–85.7 months. To me, the important finding of the research was that "Patients who reached nadir before 24 months showed poorer BCFFS (Biochemical failure free survival) than the others."

At 3+ years post treatment, I would safely put you out of the "high risk" category, which is nice to know, but this means nothing tangible. Remember that what we are looking for in PSA trending is the doubling time, not the value. Based on the PSA information you've given, there is not a rising trend yet. Given that it takes at least 3 increasing readings, your December value is going to tell the tale.

In the meantime, be watchful and discuss this with your care team. Good luck! - Joe M.

[caysary in reply to SeosamhM]

Agreed. Thanks.

[NanoMRI]

curious about why 4 mo ADT and did you not have a PSA timeline mapped out with doc?

[caysary in reply to NanoMRI]

Good point Nano. They didn't so here I am.

[NanoMRI in reply to caysary]

Because I had RP I did not have to question nadir, even after my salvage RT. However, looking back, while I pondered treatment strategies post RP and again post salvage RT, my remaining cancer grew and spread, as far as my para-aortic nodes, at PSA 0.11. .

[caysary in reply to NanoMRI]

Yes. Your profile goes into this paradox. Glad you're stable.

[NanoMRI in reply to caysary]

Thank you.

[Don_1213]

Actually your profile seems a bit sketchy - not a lot of info to go on there. I did notice you've been concerned for some time with your PSA in prior posts to this group.. have you discussed this with your medical oncologist? What's he have to say about it?

[caysary in reply to Don_1213]

He is on vacation till the tenth

[janebob99]

Since there appears to be a rise in PSA after a nadir, you may want to get a MRI or PSMA-PET scan at this point.

[gsun in reply to janebob99]

Too early for that.

[caysary in reply to janebob99]

Nadir may have not been reached yet according to one case noted above. This is the question.

[doc1947g]

Your profile is INCOMPLETED.