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reaching nadir?

califvader's picture
Posts: 108
Joined: Aug 2010

i finished imrt treatment in june of '11.  since then my psa has steadily dropped.  i've been getting it checked every 4 months.  started out at 5.1 just before treatment and now i have had a reading of .2 the last two psa checks.  i would imagine that will be my nadir.  is there any chance that the psa could increase again?

Kongo's picture
Posts: 1166
Joined: Mar 2010

As you may know, sometimes a PSA bounce takes place but you seem to be at or near the end of the period where that might occur.  If you stay at this level for some time and then it starts to rise the cause could be related to a recurrence.  From your previous posts I think you're tracking quite nicely and I would put the worries out of your mind.




Posts: 694
Joined: Apr 2010
To answer your question, Cal, yes--your PSA may rise. But it also may go lower. Anxiety is par for the course; however, with the info provided to date, it is impossible to know if .2 is your nadir (lowest point). Several more PSA tests are needed over time to determine whether you've reached nadir or if you're continuing on a downward trend. 
In previous threads, you indicated that your rising 5.1 PSA was a recurrence following an RP many yrs earlier. Your RT in 2011 was a salvage tx (SRT) to the prostate bed (and possibly to local lymph nodes not removed during RP). I seem to recall you opted not to use a protocol of short term ADT with SRT, choosing SRT alone. 
Most sources cite median time to reach nadir as 1 to 2 yrs (18 mos) post RT.  That said, every PCa case is slightly different & each patient is unique with varying times to nadir. 
PSA bounce is a rise and then decline in the PSA level after RT. The bounce phenom is more commonly seen when RT is the primary tx and the prostate is radiated. Bounce may be possible but is less likely to occur post RP with ART or SRT.
The important thing is to continue to track PSA to determine when you've reached YOUR nadir. After both RP AND SRT, with no prostate, the hope is that PSA continues in a downward trend to an undetectable level. This is usually considered to be <.05 or <.1, depending on the lab and assay used. 


Kongo's picture
Posts: 1166
Joined: Mar 2010

Well said.

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