PSA after Salvage Radiation - Prostate Cancer A...

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PSA after Salvage Radiation

billd9946 profile image

Hi guys!

I had a prostatectomy in July 2015 and my PSA fell to around .04 following surgery. It has steadily increased over 5 years to .42. I have had a PSMA scan and nothing shows up. In December I decided to go ahead with Salvage Radiation Therapy and completed my 39th treatment in early February 2021. Two weeks prior to completing treatment, my PSA had decreased from .42 to .31. Now 3 months after treatment my PSA is down to .22.

I'm feeling disappointed that it hasn't gone down more, but I'm not sure how quickly one's PSA decreases after Salvage Radiation. Has anyone out there had the same experience who can share some insight? I'm wondering if after 3 months my PSA could still continue to drop, or if .22 is likely as good as it will get. Also, might there be any other options at this juncture in time? I still say no to ADT.

Thanks in advance for any feedback! Have a great Sunday!!

14 Replies

As a rule of thumb, down by half in 3 months is about average. Radiation takes a while to actually kill the cancer. It plants a hydroxyl radical in its DNA, and the cancer doesn't actually die until it undergoes mitosis ("mitotic catstrophe"). Radiation often puts the cancer in cell cycle arrest, so it can take quitee a while until it undergoes mitosis.

billd9946 profile image
billd9946 in reply to Tall_Allen

As always, thank you for your response!

I had RP in January 2020 and radiation in October/November 2020. My PSA was .09 after surgery and was .12 before radiation. The fact it was going up is why they had me start radiation, my doctor said direction it is heading is more important than actual score. Post radiation I was .06 in Dec 2020 and .03 in March 2021. Doctor again said fact that it is going down is what matters and that is takes time to go down. Since yours is going down, hopefully good news and just need to give yourself time. Hope this helps!

Thanks for your reply! Seems you're responding very well to therapy. I have my follow up appointment tomorrow to discuss my results with the doctor and expect to hear just what you've expressed here. Take care and continued success!


Like you I had a prostatectomy although mine was in 2001. My PSA was 0.04 for only a year before climbing slowly over 3 years to 1.11 by early 2004. Despite my oncologist suggesting them I refused to have hormones pre salvage radiation and went for the course of radiation in July 2004.

PSA after 3 months was down to 0.48 and then slowly decreased until 2 years after radiation it reached its nadir of 0.17. It has never got down to my post op nadir of 0.04 again though.

Like you I was so alarmed and disappointed when it started to rise again, so can fully identify and understand how you feel.

Best Wishes - Brian.

billd9946 profile image
billd9946 in reply to Jaffa_2001

Hi Brian... thanks for sharing. What is your PSA currently? It dropped quite a bit after treatment and within a fairly short amount of time, so that seems a good thing. Anyway, they say it's key to keep a positive attitude. It's not always easy,, but I'm working to keep that in mind. Best to you!

Jaffa_2001 profile image
Jaffa_2001 in reply to billd9946

My PSA has steadily increased over the last 14 years and currently stands at 9. My PSA doubling time has been on average about every 36 months. The NHS consultant that performed my RP always said they would consider ADT when my PSA reached my pre-op level which was 15. He retired a while ago and the current crop of NHS consultants feel when it reaches 10 - I should consider starting ADT. I have an open mind about when to start ADT, but learnt a long time ago not to make any hasty decisions. Here in the UK you have to take control of your situation; after 20 years dealing with this blasted disease I do all of my research online and temper that with how I feel and then discuss that with the NHS consultants. When I was originally diagnosed in my 40's I made snap decisions because it was all new and frightening; plus the NHS said I should decide what to do, they offered very little guidance then unlike they do now. If I was diagnosed now I would have delayed the RP and just waited to see where the PSA was heading and at what speed. Hindsight is a wonderful thing isn't it? - All the very best B.

billd9946 profile image
billd9946 in reply to Jaffa_2001

Hey Brian... the good news is that your doubling time is way more than 12 months. Something to consider... there are ongoing trials now involving immunotherapy for folks in your exact situation. One month after I pulled the trigger on radiation therapy, I was contacted by my former medical group to see if I wanted to participate in the trial. It was too late though, at least for now. I’ve got to wait and see where my PSA goes and can only participate if it begins to rise again. Have you had a PSMA scan? It too is in trial, at least here in the states, and I was able to participate, but it revealed nothing. I’ve also had the Axumin scan, but it showed nothing as well. In addition, my doctor told me that research is well underway to expand the PSMA scan to include a special agent that will bind to the protein layer of the prostate cancer cell, just like the PSMA agent, but take it one step further and destroy the cancer cell. Sooo... at least there is still much hope for us both. I’m interested to know what you decide... please stay in touch. BTW, I did do hormone therapy, but it made me so depressed I had to stop. We’re all different and some do fine, but for me it was a no go. I will say, however, that up till now I’ve felt I had the choice not to go there. Everything is subject to change. Take care!

Jaffa_2001 profile image
Jaffa_2001 in reply to billd9946

Not had a PSMA scan - only had MRIs & Bone Scans all negative, but they were performed a couple of years ago now. My first MRI showed a small lesion in my prostatic bed, but that has not changed in size since then. Will certainly discuss these options when I have my next PSA test and consultation in a few months time, plus I will my research here in the UK. Thanks for that information and I will update you as things progress in case there is something that may be of use to you on this journey. B.

"my doctor said direction it is heading is more important than actual score"

Yes, pay attention to the doubling rate.

Sometimes it seems psa has a mind of it's own. But in the doubling rate there is truth.

billd9946 profile image
billd9946 in reply to cesces

Thank you... I’ll keep that in mind. Take care!

After radiation my PSA went to 0.00 and stayed for 1.5 years. Disappointingly, it's been slowly rising over the past 7 months to 0.11. So, the pelvic radiation didn't catch it all. Another PSA measurement in June will determine what procedure and treatment comes next.

billd9946 profile image
billd9946 in reply to JohnZi

Hi John... thank you for responding. How long after radiation did it take for your PSA to get to 0.00? Have you had an Axumin or PSMA scan? Maybe one of those would show where there is an issue. Also, there are trials going on now involving immunotherapy. More tools in the arsenal for folks in our situation.

Thanks, Bill. My PSA actually was 0.00 right after radiation. Thought we nailed the bugger for good, but, as I mentioned, 1.5 years later,it's been slowly rising. Whatever happens, I do not want ADT which I had along with radiation. Lupron made me feel the most uncomfortable living in my own body ever, and I never want to go through that again. I haven't yet had an Axumin or a PSMA, and depending on how things go, one of them may be in the works, Right now, I'm told that my PSA levels won't reveal positive scans yet with them. New radioisotope ligands for use with PSMA PET are about to be approved. Luckily we have so many more tools to make treatment decisions.I'm pretty optimistic. Hopefully, I'll be among the many men who die with PCa than from PCa.Jack

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