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PSA rise from 3.6 post external Beam Radiation to 5.1 after 2 years

blwms
Posts: 1
Joined: Jul 2012

First PSA reading 30 years ago was 9.8 with a negative biopsy. Extremely large prostate and readings continued to climb over many years with 6 negative biopsies. Two years ago at 44.6 my biopsy came back positive. Had Radiation (EB) and after 90 days Psa dropped to 7.4 then after 18 months dropped to 3.6. Now 2 years after treatment PSA has risin to 5.1. Urologist assistant thinks some further treatment, probably hormone injections, will be needed. Meeting Next week with Doctor. My question is, should just one increase in PSA be a determining factor in further treatment?

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Kongo
Posts: 1167
Joined: Mar 2010

Welcome to the forum. Your information is a bit confusing with the numbers suggesting a PSA reading 30 years ago (PSA test wasn't used then) and other numbers but regardless of what may be typos, I think the gist of your question is should you seek further treatment based solely on a single PSA reading which increased over the previous test. While I don't know what type of radiation you received, you don't determine a failure (and thus need additional treatments) until at least three consecutive PSA rises where the score is 2.0 above nadir.

There is phenomenon associated with radiation treatment called the "bounce" effect. That is where the PSA levels after treatment drop steadily and then bounce back up for a while then continue on their downward course. Doctors don't really know what causes PSA bounce but it occurs in about 30% of men who have had radiation treatment. (I am going through one myself at the moment). This is a normal effect of radiation and my radiologist told me that there is evidence that men who have a bounce actually have better long term results. They don't know why.

In any event, you need to question your urologist closely about why he would want to do further treatment based on just this one PSA reading. You may wish to seek second opinions as well.

Another thing to keep in mind about PSA testing after radiation...all of the things that can cause PSA to rise such as sex before the blood draw, certain types of exercise that put pressure on the prostate (like bike riding), certain OTC medications, a DRE exam, and even an unusually hard stool can cause temporary PSA elevations.

The urologist assistant seems to be misinformed here. Other things he ought to be considering before HT is the possibility of continued elevated PSA from BPH, prostatitis, an undiagnosed UTI or some other irritation that can cause elevated PSAs. Question the doctor directly and good luck to you.

K

Swingshiftworker
Posts: 634
Joined: Mar 2010

Kongo:

Just to clarify, I believe that the 2 measures of recurrence following radiation treatment are independent of each other. The way you worded it above suggests they are interconnected.

I think it's either 3 consecutive increases of any amount w/in 2 years w/quarterly tests for 1st 2 years and semiannually thereafter (the 1997 ASTRO Conference Consensus) OR a rise of 2 ng above nadir (the 2005 joint ASTRO and RTOG Conference in Phoenix). For a discussion of the different standards, see:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892622

I don't think there's enough data presented by blwms to determine if he qualifies under either standard yet. More info is needed.

As for the urologist assistant, I would NOT rely on anything s/he has to say and I agree that blwms should discuss his situation w/a qualified physician before doing anything further.

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Kongo
Posts: 1167
Joined: Mar 2010

With everything you wrote.

Samsungtech1
Posts: 350
Joined: Jan 2011

Just courious because if thisnhas stretched out over 30 years then it would seem slow. How many positive cores did you have two years ago? Not sure, but I think your age is going to be the determining factor here. Why don't you have an oncologist? Too many unknowns to make a judgement call, but you need to give more info, and explain what doctors you are currently seeing.

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