Weird PSA kinetics

[Chasbearcat999]

DX 4/23. PSA 8.6.

SBRT 10/23. PSA 9

12/23 post SBRT PSA 11.96

2/24 PSA 9.34

5/25. PSA. 4.85

8/24. PSA 6.48

Today. PSA. 5.9

Opinions from 2 RO’ feel that the 6.48 was a bounce and my case is complicated by prostatitis. I am constantly taking Aleve for the dull ache in perineum.

I meet with primary RO today.

Last week URO did basic urinalysis and said “no prostatitis” It seems like that’s not how you rule it out.

Both RO said that ANY drop in PSA after 6.48 would be indicative of a bounce.

But a year out from treatment I would think the PSA would be lower.

Both RO’s said that while I'm an outlier, the trend down is more important.

Any thoughts, suggestions, experiences appreciated.

[Justfor_]

My take is that the 4.85 isn't in line with the rest, not the 6.48.

[Tall_Allen]

"It seems like that’s not how you rule it out." I agree. You obviously have prostatitis. It will always relapse and remit on its own, and drive you crazy.

[Chasbearcat999 in reply to Tall_Allen]

The RO said that he suspects that I had prostatitis prior to radiation and the radiation exacerbated it. He said often it wiil relieve it. But I'm one of the unlucky one. He said that PSA monitoring is tricky in patients like myself. He said it’s 2%-3% of the population. He said the trend is key, and baseline will probably be higher for a couple of years. He said the “gold standard” is prostate milking. Which he did not feel was necessary. He also felt 6 weeks of Cipro didn't have a good hazard benefit. So I'm on a 2-month PSA schedule. And imaging will be most useful in monitoring if things get too weird.

[Bfit01]

mine went from 1.37 to 6.5 over the course of three years after proton therapy and then has trended down since with most recent PSA, 6 years after treatment, at .24. I would agree with the doc and just keep monitoring…

[Chasbearcat999 in reply to Bfit01]

Thank you!