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rising PSA post Radiation

Posts: 1
Joined: May 2012

In Aug, 2010, I was diagnosed with PCa (PSA-29, Gleason 4+3). In Dec, 2010 I began a 6 month program of Androgen Deprivation Therapy and had IMRT beginning in Feb. 2011. Since that time, my PSA has been raising and, to me, seems high. My results are as follows (note- the 5/31/11 test was while I was still on ADT, which ended in mid June):

PSA <0.1 05/31/2011
PSA 0.9 08/30/2011
PSA 1.2 11/29/2011
PSA 1.2 02/27/2012
PSA 1.4 05/22/2012

My urologist says “Your PSA remains stable.”

I haven’t been able to find out much about post radiation PSA levels, but what I have found would indicate that my case is unusual (to say the least). My PSA seems high and seems to be on an upward trend. When a PSA reaches 2.0 post radiation, it usually is taken to mean the treatment failed.

I am on this forum looking for information (how common ARE my results so far), advice, opinions, references to published research, etc.

Posts: 1013
Joined: Mar 2010

I too have been concerned about my post treatment PSA levels, which were very erratic and is still at 1.55 and has not dropped under 1 (a generally accepted indicator of success) over 18 months after treatment, and have taken the time to do considerable research in the the possibility of recurrence in my case.

See: http://csn.cancer.org/node/237864 and http://csn.cancer.org/node/226425

There are 2 commonly accepted measures of recurrence of prostate cancer following radiation treatment after reaching your PSA nadir (lowest level):

1) 3 consecutive rises in PSA regardless of level (ASTRO) or
2) a rise of 2 ng/mg at any time (Phoenix).

I think that you qualify under the 1st measure and I think you're right to be concerned. However, your PSA level has apparently stabilized after the early increases (certainly w/in the degree of measurement error and I can see why your urologist may not be as concerned as you are.

However, it's your life and if you are seriously worried, I think that a follow-up biopsy and would be warranted (assuming you're willing to assume the risks of that procedure again) BUT the biopsy is no more accurate in determining recurrence as it is in detecting the onset of PCa to begin with. So, it may not indicate a recurrence of the cancer even if it has occurred. However, if may indicate recurrence and that's what you are concerned about.

You might also consider requesting an MRI w/IV contrast and a rectal balloon to try to determine if there has been any migration of the PCa but this procedure has apparently only been used for post surgical patients to do so: http://www.eurekalert.org/pub_releases/2011-04/asfr-mlp042811.php.

Fact is, there really is no "sure way" of determining whether your PCa has recurred or not, except when the PSA measures go to the extreme or after the growth or migration of the cancer can be detected by MRI, CAT or bone scan by which time it may be "too late" to do much, if anything, about it.

See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477545

Good luck!!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3661
Joined: May 2012

A buddy has been stage 4 for two years, and his PSA was 260.00 when he began a pallatative new drug two months ago. He is down to 40.0 now, and he hopes it continues to drop.

He had numerous radiation treatments about three years ago (prostate removed 12 years ago)which damaged his colon, but I do recall that his PSA went up following the radiation, to around 30, if I recall correctly.

Good luck !

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