Do I have to worry about a recurrence?

[Yearofthecow]

Curious about anyone else's thoughts on this, or if anyone has had a similar situation.

I had SBRT on 9/24/2022 with Dr. Kishan at UCLA using ViewRay, Image guided SBRT no ADT.

Been on Avodart since 2013.

PSA prior to the SBRT was was 2.7 ng/ml 8/9/2022

3 months later the PSA dropped to .92 ng/ml 12/2/2022

The PSAs are the following:

12/2/2022 .92 ng/ml

3/2/2023 .40 ng/ml

6/9/2023 .49 ng/ml

9/11/2023 .44 ng/ml

11/29/2023 .44 ng/ml

3/4/2024 .52 ng/ml

9/6/2024 .54 ng/ml

9/24/2024 MRI Performed at UCLA, no evidence of prostate cancer

3/18/2025 .68 ng/ml

The .68 ng/ml is very concerning to me, along with what seems to be gradual increases since 11/2023. In general it seemed like mostly mid .55 ng/ml, then in 3/18/2025 it jumps .13 ng/ml. That seems like a lot.

Not that I am grasping at straws, but is a PSA bounce possible 2 years 6 months after treatment, and does this pattern even resemble what a bounce would look like?

I have an appointment with Dr. Kishan on April 11, where of course I will ask him about it.

Any thoughts or input are appreciated.

Thanks,

John

[petabyte]

Maybe you already tried this. It is from chatgpt (o3-mini) and seems reassuring.

chatgpt.com/share/67db1cf2-...

This is perplexity (pro)

perplexity.ai/search/someon...

[Yearofthecow in reply to petabyte]

I didn't even think about chatgpt. That is a great idea. Thanks petabyte, I really appreciate it.

When I see Dr. Kishan on April 11 I will ask him if a PSMA would be worth considering.

Thanks,

John

[addicted2cycling in reply to Yearofthecow]

redjournal.org/article/S036...

[Yearofthecow in reply to addicted2cycling]

Thanks addicted2cycling.

seems it can be quite variable for some when they indicated in that study that 1 in 13 experienced a bounce of NADIR +2 ng/ml by 5 years".

Next month I will be talking about this with my radiation oncologist.

John

[Yearofthecow]

Just adding a little more information. Before my up coming appointment in April the NP did get back to me regarding my PSAs with the following response:

"This is very common for the PSA to move around a bit, and since you had a negative MRI prostate in 9/2024, I would not be concerned for recurrence at the time. If the PSA continues to rise to >1.0, then we can consider additional imaging. No need to come in person if you don't wish to, we can keep the telehealth visit as planned if that is easiest for you."

While somewhat reassuring, I am still concerned, because nothing is perfect including MRIs. I plan to ask Dr. Kashan his thoughts about having a PSMA, and if that would shed more light.

[ron_bucher]

I would never advise anyone to worry per se, but I think there is a greater than zero possibility of recurrence in practically every case. That's why the best doctors are reluctant to use the "cure" word even when the numbers look great.

I'm pretty ignorant about PSA from a radiated prostate, so one of my questions for the doctor would be how differently PSA from a successfully radiated prostate should behave compared to PSA from an untreated prostate. It appears your lowest PSA was 0.40. If my math is correct, at worst the increase over two years is 70% (and still relatively low numbers?). What PSA trajectory might be of concern from the doctor's perspective? When does he normally recommend PSMA scan after radiation? I assume they did a PSMA scan prior to your SBRT?

[Yearofthecow in reply to ron_bucher]

thanks for your input Ron.

Yes, I had all the diagnostics done before the SBRT, and had a low decipher score.

What they told me though is that they get concerned if the PSA increases over 1.0 in my case, and then they would do another PSMA and or MRI. It is usually 2.0 for those not on ADT, but I am on Avodart so I suspect that it why they used 1.0.

I did have the PSA done again, a week later at Quest, and the value was .47 ng/ml, which is in line with the previous results I had at Quest for Ultra Sensitive PSA:

2/22/2023 .59 ng/ml

7/3/2024 .51 ng/ml

12/2/2024 .56 ng/ml

3/25/2025 .47 ng/ml

It is important that tracking is done by the same lab, and not mix results from one lab with another since possible methodology difference, which I do and maintain different lab's PSAs separately from each other.

I mention that for those in similar situations who browse these threads so monitoring consistency is maintained within the same lab.

The PA also told me that the PSA values can fluctuate a lot, and it can take as long as 5 years before NADIR is reached, with possible bounces along the way,

This is only for those who have done radiation without ADT. Those who have had surgery or ADT it is entirely different.

I have my appointment with the doctor next week where I will ask him those questions.

I was reading your profile and it makes no sense to me why they would block your link to Dr. Steinberg. He is a well know physician at UCLA, and very credible. In fact all your links are informative and excellent. I would be curious why the mods blocked it.

Anyway, thanks for your input, and wish you all the best.

John

[ron_bucher in reply to Yearofthecow]

It sounds like your PSA trajectory has not merited any worries! And if it does become an issue, maybe you'll be one of the lucky guys who gets great benefit from SBRT on tumors if/when they appear on PSMA scans (maybe with or without ADT!).