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

Short Answer: NO!
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

Kongo said:

Short Answer: NO!
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

Measures of Recurrence Following Radiation Treatment
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.