I went yesterday for PSA test. I'll post the history below, but it has been a rollercoaster.
First a spike after SBRT. Then some lowering, then a decent drop. Then a "bounce" The last few tests seemed to show a resolution of the bounce but yesterday but was more definitive.
RO feels prostatitis is muddying the waters and I may have to accept a nadir between 1.5 -2. But <1 is still very possible. SBRT is great, but it can be a tough ride.
He is an interesting guy who I feel looks at each case individually. For instance, I'm 4+3 with cribiform. When, we were planning treatment and ADT came up, he felt that it wouldn't give the "currently accepted" cost/benefit studies show based on small lesion 3ccm3cmx6cm, low tumor burden overall and (in his opinion) very low volume of 4, with a low % of cores, and something I don't really understand- " a lot of discontinuation in cores. He felt despite it showing some aggressiveness with Decipher showing a lower than average risk of metastasis and a smaller amout to deal with that SBRT would "overwhelm" the cancer.
Sorry, a lot of typing. Anway, here is my history-
and even that is subject to interpretation. as TA has noted continually, there is such a thing as benign PSA. But the PSMA scan should make all that moot and certainly by 2.0+ you're going to get an accurate PSMA scan.
you can always get a PSMA scan but I'm sure he won't want to do it as long as things are going down and probably not for at least a couple years or maybe even three afterwards also. Your doctor is correct that one size fits all is not a thing for PSA. It's a very helpful guide but not the be all and end all
I noted your psa stats with interest because there were similarities in my diagnosis and treatment, ie SBRT with no ADT.
I, too, needed reassurance. This week, I reached the point of my annual review (de facto 11 months from the end of RT) but only had the opportunity to discuss matters over the phone with a specialist nurse. In the UK, it is difficult to have a face-to-face meeting with a specialist nurse these days, never mind the RO.
The outcome of the telephone consultation was that they are happy as long as the psa remains in a downward trajectory until an individual nadir is reached. That nadir will be different for each person. As you will know, they only become concerned and want to get involved if the psa goes back up by a minimum of 2 ng/ml from the eventual nadir and persists on an upward trend from there. As you will also know, everyone's nadir has a different timescale.
As you allude to, it is difficult to gauge individual treatment outcomes and to achieve reassurance. Despite my discussion with the specialist nurse I still don't really know how well I am doing. For example, I know of someone who achieved a psa of 1.28 just 3months after the end of RT with no ADT!
Like you, I eventually hope to achieve <1.
For interest and comparison here are my stats.
13.136 - Feb 2024 last known psa before treatment.
19 Apr 2024 - Last RT (5 Hypofractionated VMAT) - no ADT
The Following is Calculated as 28 day or 4-week months.
PSA
6.11 - Jun 2024 (47 days or approx 1.67 months or 1 month 19 days)
3.424 - 5 Sept 2024 (139 days or approx 4.96 months or 4 months 27 days)
3.04 - 23 Oct 2024 (187 days or 6.8 months or 6 months and 19 days)
2.563 - 28 Dec 2024 (253 days or 9 months and 1 day)
2.255 - 17 Mar 2025 (331 days or 11 months and 23 days)
My PCa diagnosis:
Gleason 3 + 4 ie 90% of 3 and 10% of 4
Grade 2
T2c NO MO - The urologist initially said It was T2a but changed his mind and agreed T2c after I queried that the PCa was on both sides of my prostate, so should perhaps be classified as T2c.
MRI indicated a 14mm tumour on the left lower quadrant
Transperineal biopsy - 6 out of the 15 cores had PCa. 3 out of the 6 cores were on the left side and were 1.3mm, 5 mm, and 9 mm. 1 out of 6 cores was on the left 3+3 and 1 mm.
Cells - Adenocarcinoma - micro acinar
No cribriform features
No evidence of EPE or Perineural Invasion
DRE - normal
PSA was 13.1 in July 2023, then 13.37 in September, and 14.32 in November - a velocity increase of 1.22 over 4 months. Then 13.136 - Feb 2024 my last psa before RT.
It looks like your numbers show a pretty solid respone. Mine were complicated by an initial "spike" on the first test . (Happens about 10% of the time, folowwed by what appears now as a classic psa "bounce" at 10 months. then resolution and drop. Both RO and MO said the numbers matter less than the downward trend. It can be unnerving, but you trust that they have seen this much more often than we have.
But I agree, when you see these really low numbers from others at 6 months you wonder if the treatment worked for you.
I was also told by the be bo (MO and RO) not to expect a nadir before 2 or 3 years.
The feedback I get from a specialist nurse is quite limted and superficial. The most I get out of it is that the psa is still going down, so that is good!
I asked how I compared and was told I was average. Due to the sparsity of feedback I started online reading about the stats and started to worry, so I stopped.
It seems we will just have to wait and see how it goes. As you say our respective nadirs can be in 2-3 years. I have noted some as late as 4 years! It is all so individualised
I did anticipate a potential bounce at 11 months, but my one may be yet to come. Even though it may be anticipated it can still unnerve you!
IIRC I think that T.A. said that a bounce can be viewed in a positive light.
2.563 - 28 Dec 2024 (253 days or 9 months and 1 day)
2.255 - 17 Mar 2025 (331 days or 11 months and 23 days)
I was explained that as the number lowers, the decline slows. But if you look overall, you are down 82% with a continuing downward trend after 17 months. That is a pretty robust response.
If you extrapolate your later, smaller drops and stay on a slower trend, you are still looking at .71 at 2 years. (I used Excel)
Again, it seems you were given the same advice as I was; as long as it keeps dropping, it's the trend, not the number in the first 3 years.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
PSA 6 months after RT
My prostate journey and testosterone side effects
PSA bounce
Newly diagnosed and looking for advice....
