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This is why you don’t do radiation as primary treatment

Posts: 301
Joined: Dec 2017

As you all know I did a combination of radiation treatment and I had many bad side effects and I'm still bitter about it below I will  is my one and a half your follow up and when I asked the DR how low should my PSA get so I will know if the treatment was successful  what is the nadir to be so I can proclaim that I am cancer free this is the answer I got....quote .           

There is no evidence of local disease. Your PSA is heading the right direction. Your PSA is below the normal range and there is no cut off. We follow PSA trend after definitive radiotherapy.   Really this is horse crap look at these publications I  found                         This is from Harvard Health 

Neither the physician nor the patient should have a false sense of security if the PSA is 2 or 3 ng/ml. It means that the patient has residual or recurrent prostate cancer. Often, the PSA is the first harbinger of recurrent disease, even though it may predate any symptoms or clinical evidence of the disease by months or years.

For the patient treated with radiation, the evaluation is a bit more complex. Often the value does drop to zero. If, however, the value is 1 or 2 ng/ml, it may be the case that some of the normal prostate tissue survived radiation treatment and is still producing PSA. If the value continues to rise, there is reason to be concerned that either cancer has spread outside the gland or the radiation treatment did not eradicate the cancer within the gland. Recent studies have shown that for optimal results, PSA levels should be lower than 1 ng/ml, and even lower than 0.5 ng/ml. Levels that are above 1 or 2 ng/ml 12 to 18 months following completion of radiation treatments are very worrisome, because they indicate that the cancer may not have been eradicated.                                                                              




Achievement of nadir PSA ≤0.5 ng/mL after completion of dose-escalated radiation therapy was associated with improvement of all prostate cancer endpoints


I will be sending my doctor these publications and see what he has to say.       Theses are my results    


Standard Range
Prostate Specific Ag
<4.00 ug/L
11/6/18 4.159
2/7/19 3.454
5/2/19 3.408
6/18/19 3.998
8/28/19 2.560
11/6/19 3.017
2/12/20 2.077
Posts: 223
Joined: Jun 2016


Your PSA is trending down which is good sign I hope you will soon reach your nadir point and be happy with result.

Hopefully, you will stay cancer free and enjoy your life.


Posts: 301
Joined: Dec 2017

Yeah hopefully but my doctor said there is no cut off and this guy is a top radiologist at the number for supposedly cancer center in America what a crock of **** I'm bout ready to read him the riot act

Coldbiker's picture
Posts: 23
Joined: Jan 2016

We all wake up everyday after a cancer diagnosis with a choice, to be bitter, angry, and lashing out or we can be thankful and have a good day. Both are valid, one is good for the soul. You seem to be attempting to recruit people to validate being bitter, so far it's not working and that's a good thing. Your Dr is right, With RT there is no cutoff until a personal  nadir is reached then poof there is YOUR cutoff. There are optimal ranges, which is different until your nadir is reached, useless to compare where you are.  If you has ADT also, as I did then that complicates it. It can take 3 years to reach nadir according to what I have told/read. Reading the riot act to a Dr because he is not telling you what you want to hear, yeah good plan. Get another opinion if that what it takes 

VascodaGama's picture
Posts: 3371
Joined: Nov 2010

Well Steve,

A drop of the PSA in 15 month from 4.16 to 2.08 is to be congratulated. Let's celebrate.

I believe that you are on the good path to victory. That nadir of 0.5 ng/ml is now closer. The publication you refer in your above post indicates medium values from a group/cohort of patients with similar status and therapy. Some in the group had higher conclusive values and some had lower but in the end they all fared well. You seem to belong in the group of those that reached success.

I will drink a glass of my Portuguese red Esporao. How about joining me?



Posts: 393
Joined: Mar 2017

And RP surgery fails as well. You need to get over agonising over your choices and move on.

lighterwood67's picture
Posts: 295
Joined: Feb 2018

I can remember when you were researching what type of treatment.  You did your research and made your choice.  Looks like to me you are having excellent PSA results from your treatment albeit, you did have some side effects issues.  You need to be celebrating these results and quit beating yourself up.  Mental anguish takes a toll on the body and could be impeding your recovery.  PSA declining every couple of months or so.  Set the fireworks off.  Give yourself a break.  Anyway great news. Don't worry about the nadir.  Worry about Steve.  You are on a good journey young man.  You are a success story.  None of our journeys are easy.  Go have that toast.  Best of luck to you.

Posts: 693
Joined: Jun 2015

Hi Steve,

Sounds like your heading in the right direction with your decreasing readings.  Hope for many more in the future.

Dave 3+4

Posts: 301
Joined: Dec 2017

The quote from my dr disturbs me ..there is no cut off..there has to be some form of nadir ..I want to know what that may be ..that publication is from Harvard health ..well will see what he has to say when I emsil him back 

lighterwood67's picture
Posts: 295
Joined: Feb 2018

After radiation therapy

Radiation therapy doesn't kill all of the cells in the prostate gland, so it's not expected to cause the PSA to drop to an undetectable level. The remaining normal prostate cells will still make some PSA.

Posts: 693
Joined: Jun 2015


Sounds like your Psa is falling to a certain level, if it stays there and does not increase it would indicate to me that your cancer is in remission.  As with all of us if your Psa starts to rise again over several readings it should be investigated by your doctor.  Just hope that once it bottoms out at what ever number it stays there.

Dave 3+4

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3666
Joined: May 2012


I would say that your post-radiation PSA trend is more indicative of cure than of relapse.   One of the key reasons I ultimately chose surgery rather than IGRT was that if surgery is successful, the PSA goes almost immediately (within a few months) to Undetectable, and then stays there.   I am too much of a worrier to deal with the normal PSA oscillations and bouncing around that R.T. inevitably (and normally) brings, even when completely successful.   Your history is textbook "successful," but there is no "proof" yet, if there ever will be.

Don't be one of the guys who either are always of the opinion that "Surgery always sucks" or, alternatively, "Radiation always sucks."  It is more accurate to say that both usually are pretty much successful and effective.  Both at times have sad results in some individuals.   You are likely OK.  I hope you can feel good about that.


Georges Calvez
Posts: 532
Joined: Sep 2018

Hi Everybody,

This is endlessly chewed over, not only here but elsewhere.
This is a discussion on another place where I also contribute, hopefully it will not be taken down!

Best wishes,


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