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PSA After SRT

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

I am trying to get a handle on PSA behavior after salvage radiation therapy.

 Halfway through a 6-week course of radiation therapy my PSA dropped from 0.3 to 0.2. This was encouraging because it seemed to indicate that the radiation was on-target and working. However, two months after completion of SRT, my PSA went up again 0.3.

 I am thinking the 0.2 reading three weeks into SRT may have been bogus because I can't imagine radiation having such an immediate effect after only three weeks. Anyone have a similar experience?

 For those of you who have had SRT following a rise in PSA after an RP, did your PSA bounce up and down before it settled, dropped, or began to rise?

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No symptoms prior to dx.

2013/08 Routine blood test revealed high PSA of 13 (12.7). DRE negative.

2013/11 Transurethral bx revealed cancer in 7 of 21 cores. Staged T1c (DRE negative), Gleason 7.

2013/12 2nd opinion upgraded Gleason 7 to Gleason 8. Scheduled surgery same day.

2014/02 RP with da Vinci robot at Tokyo Medical University Hospital. Catheter removed 8 days later.

2014/03 Post-op path report confirmed Gleason 8 and revealed up to 7 tumors ranging Gleason 6, 7, 8. Seminal vesicles and both pelvic lymph nodes removed and dissected, both vesicles and nodes were negative for any sign of cancer. One margin suspect (pathologist could not decide if it was positive, so it was judged “to close to call.”). Right nerve bundle was taken, left nerve bundle spared. Final staging T1cM0N0.

2014/03 Good recovery from stress-urinary incontinence after 6 weeks, pad free after two months post surgery. ED remains a problem.

2014/08 Hospitalized again to repair large hernia at ventral da Vinci incision above the navel.

2014/09 PSA levels (tested every 60 days since surgery) 0.1, 0.1, 0.1, 0.2, 0.3.

2014/09 Started SRT (EBRT), 30 sessions (6 weeks), 2 gy per session. After third week of SRT, PSA dropped from 0.3 to 0.2. PSA reading after SRT on 27 Oct: 0.2

2014/12/22 Latest PSA: 0.3 (up from 0.2)

BLUEpac6
Posts: 43
Joined: Jun 2012

jan.2009 found out my psa was 110 and after biopsy agressive carcinoma but was never found uot of protrate so had radical surgery in aug.2009. By 2011 psa had risen to .06 and was told I would have to have salvage radiation as the cancer was rturning.July 2011 had 35 radiaton treatments and psa afterwards was less than .01.psa aug.2014 was .011.thats the way my case went as every onea seem to be differnt.Iam feeling fine and have had no side effects from anything except ED.pray you do okay.My psa never jumped aroun after surgery or radiaton. my psa was never checked tiill 60 days after radiation and every 6 mo.afterwards.

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

Blue, thank you for your thoughts and kindness in replying. Have a nice holiday.

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

My doctors took a PSA reading three months after radiation treatments were completed. My PSA was not affected by radiation. 1.18 before radiation and 1.2 after. It continued on that path, reaching 20.4 after three years. Hormone therapy dropped it to .01>. It remains at .01> after six years.

Good luck to you.

Old-timer (Jerry)

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

Jerry, thank you for your post. I have read some of your other posts. I don't know you, but I sure love your attitude. You have a restful holiday.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

It can take well over a year for post-RT PSA to become stable.  The infamous "bounce" following RT can last longer than that. 

Following any extensive RT, the PSA ordinarily oscillates back-and-forth for some time.  Difficult to follow, but the way it works. It is possible that your radiation therapy was totally curative for you.  Just be patient and wait.  

I know, easier to say than to do. I hope it proves curative for you in the long term,

max

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

Your comments are much appreciated, and stress relieving. Enjoy your holidays. Wish you the best.

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Yank 31,

Thank you for your complementary comments. I have been so very lucky, and at age 88 I seem to have "matured" a lot. Not sure that is a good word to use. Some younger folks have said I am aninspiration to them. Comments like those stroke my ego!

Regarding your question, I have decided that a more detailed record of my PSA readings might be interesting to you. You might have seen it earlier; I posted it for someone else a few weeks ago.

July 1991, at age 65: PSA 4.0, biopsy Gleason 3+4 = 7.0.

September 1991: radical prostatectomy.

December 1991 through 2003: PSA .0.

Early 2004: PSA 0.2. Then at 3-month intervals my PSA rose: 0.39, 0.61, 1.11.

Feb.-Mar. 2004. Radiation sessions (35).

July 2004: PSA 1.20. (Informed that radiation was not successful.)

October 2004 to June 2008. PSA see-sawed a bit while gradually rising to 20.4.

June 2008. Began hormone therapy.

September 2008 to October 2014. PSA undetectable <0.1.

I am 88, feeling good, remaining relatively active, and enjoying life.

Good luck to you.

Old-timer (Jerry)

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

Jerry, thank you for your comments. The more info the better. Everyone's case is different so it helps to have some background, especially before talking the doctors. Good luck to you,  too.

VascodaGama's picture
VascodaGama
Posts: 3013
Joined: Nov 2010

I think it too earlier to trust any readings in PSA tests. Radiation treats by affecting the DNA in cell’s life cycle, therefore, it takes time to verify if the bad ones do or do not replicate. This is the reason why doctors prefer to get the test done latter at the three or more months period.

A matter of concern is that you have no initial PSA (after surgery and before RT) to compare the results. Regarding bounce, you may know that this is a phenomenon applied to patients with the prostate in place. SRT guys usually have no such experience, unless they got a tumour of reasonable size somewhere else. I believe not being your case because the previous image studies did not find such tumour and that classified you with the pathological staging of T1cM0N0.

I wonder what may be your doctor’s opinion.

Best wishes for a good New Year with better results.

VGama

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

My PSA before surgery was 13, post-op 0.1. The hospital does not use the super sensitive testing for PSA.

PSA before surgery: 13

PSA after surgery:   0.1, 0.2

PSA before SRT: 0.3

PSA after SRT:   0.3, 0.2, 0.3 (2 months after treatment)

Due to the size of my prostate (120 g) the doctor told me that he was worried about the possibility of part of the prostate being left behind. Apparently, the larger the gland, the more difficultly in obtaining decent margins all the way around. My PSA elevated from 0.2 to 0.3 at my last test two months after completion of SRT. The consensus seems to be that this is too early to draw any conclusions. Still, it is worrisome that it  went up by a very smalll amount and not down.

Yank31's picture
Yank31
Posts: 37
Joined: Dec 2013

I want to thank everyone who answered my previous post. Just had my first PSA test 4 mo. after completion of SRT. It seems to be pegged at 0.3 for now, and we are encouraged because at least it has not gone up.

So, everyone's advice and comments seems to be spot on. It will be at least 6 mo. to a year, even longer before it drops (hopefully) or at least stabilizes. Looks like this contest is going to be a marathon and not the sprint I was hoping for.

Again, thank you for your comments.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Yank,

"Not increasing" has to be a good thing....!   Vasco and several others here are the experts on PSA trends, but I am not.  I had a friend who died a year ago September, whose last-tested PSA value was over 1,000. That was the highest I had ever heard of, but I was reading an oncology magazine at the doctor's office recently, and a fellow who had at one time had a PSA of 3,700 was featured. (He is still alive and healthy, at press time.)  Hard to imagine !

Hoping your PSA never increases beyond its current .3,

max

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