Thoughts on this.

Bearcat999

I had a physical in March PSA was 9. Met with urologist in April. PSA 8.4

Over next few months, MRI, biopsy, (3+4) 5/15 positive. PSMA in July. (Clean)

Met with several doctors, which took time. Scheduled and completed Cyberknife (SBRT) on 10/9.

When I was getting opinions, I met with a MO who seemed very knowledgeable from University of Cincinnati. However they didn't have Cyberknife, so I went with a private group. I did schedule a follow up with her for 12/8.

When I went to the follow up, she assumed that I had completed treatment in Sept and I was 90 days out. (The private group isn't great at sharing records)

She did a PSA and it was 12. Obviously this alarmed me.

Talked to her this morning and she said she doesn't feel good about it or bad for the following reasons:

-It was only 2 months from completion and prostate may still be inflamed from radiati0on, pushing up PSA

-No PSA test had been done immediately before treatment, so she does not feel that 9 is an accurate baseline.

However she did say that she wanted to test in 6 weeks and if it is not lower, do another PSMA.

Any thoughts on this? How long does it take a prostate to heal from radiation?

Old Salt

Yes, I would be alarmed too. Whereas it's true that cancer cells that were hit by the radiation are still dying off, your 8-week PSA result is concerning. I agree that all that can be done for now is what the doctor recommended. In addition though, I would get another PSA close to Jan 9 (3 months out from SBRT).

Here is a link to a paper that appears relevant:

Prostate-specific antigen kinetics after primary stereotactic body radiation therapy using CyberKnife for localized prostate cancer - PMC (nih.gov)

and a video:

Monitoring PSA After Radiation Therapy | Answering YouTube Comments #70 | Mark Scholz, MD | PCRI

Let's hope that the cancer has not metastasized; your prior PSMA test suggested it hasn't, but PSMA tests aren't always totally informative because some prostate cancer cells express very little PSMA.

centralPA

Here's a good article to booknote, although it talks about a "bounce" much further out than 90 days.

https://www.nature.com/articles/s41391-021-00387-4

Clevelandguy

Hi,

If it was me I would do several PSA tests over several months to develop an upward or downward trend, this should let you know what’s going on. Like central pa said, you might bounce up and down for a while and then settle out to a relative steady number. That steady number probably won't be zero since the radiation does not kill all the Prostate tissue.

Dave 3+4