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PSA Level Post HDR Brachytherapy

Sw1218's picture
Sw1218
Posts: 65
Joined: Jan 2016

this past december, i turned 47. in feb. 2019, i was diagnosed with GS 4+3=7 PCa. in july of that year, i was treated with 6 months of casodex 50mg. until january of 2020. on january 9th and 23rd, i received HDR brachytherapy. at diagnosis, my PSA was 11.9, later that year, after going a few weeks without casodex, my PSA went up to 12.68, then after re-taking casodex,  in december of 2019, my PSA went down to 11.45. i was sched. to have my first PSA 6 months after my HDR treatments [july 2020], but because of COVID-19, my RO says i can afford to wait another 6 months to have a PSA. so two days ago, i had my first PSA and the results came back, 4.04.

this has my RO concerned because he feels that my PSA should've gone down much further, since it's been a year. i'm a bit confused because i thought as long as the PSA was going down, that's a good thing. so, i'd like to know what are your thoughts? i'm scared, man!

Clevelandguy
Posts: 688
Joined: Jun 2015

Hi,

I'm with you, if I was in your situation and my Psa went down from 11.45 in Dec. of 2019 and is now 4.04 I would think that it's going in the right direction.  I would wait for a couple more Psa tests to determine what is happening.  Remember 3 data points make a trend line. From what I understand most radiation treatments have a slow drop in Psa over a long time.  Your Psa many never drop to zero because you still have some of your Prostate gland producing Psa.  What that magic low number is I don't know.  Are you still on Casodex?

 

Dave 3+4

 

 

Sw1218's picture
Sw1218
Posts: 65
Joined: Jan 2016

Are you still on Casodex?

no. my RO told me to stop taking it on the last day of my HDR treatment.

VascodaGama's picture
VascodaGama
Posts: 3356
Joined: Nov 2010

I agree with Dave above. The nadir PSA in radiation treatments can take long time (2 to 4 years) to reach. PSA Bounce with ups and downs is typical in the first 18 months curving down to a nadir that can be high over 1.0 in guys with an initial PSA above 10.0 ng/ml.

Clinical features of prostate-specific antigen bounce after 125I brachytherapy for prostate cancer | Journal of Radiation Research | Oxford Academic (oup.com)

Best,

VG

 

Sw1218's picture
Sw1218
Posts: 65
Joined: Jan 2016

"PSA Bounce with ups and downs is typical in the first 18 months curving down to a nadir that can be high over 1.0 in guys with an initial PSA above 10.0 ng/ml."

well, thank you for lettin' me know this. i wish i had been informed. funny thing is, my nurse practitioner said her goal for my PSA [4.04] was to be at least less than 1/2 of what my highest PSA [12.68]. it was that, but she and my RO still wasn't satisfied enough. my RO feels that my PSA won't go lower. this is what has me all wired up.

VascodaGama's picture
VascodaGama
Posts: 3356
Joined: Nov 2010

You are welcome.

I would think that you see a lower PSA in your next test three months from now. The nurse treating you may be thinking on seeds-Brachytherapy of lower doses. These show shorter periods in reaching the nadir (nPSA) because their radiation effects are lower and involves shorter area of influence than the HDR procedure. Typically the nadir is seen in 8 to 12 months (1 to 2 months of absorbed radiation plus 6 months of cell's life cycle).

For the moment being let's celebrate the lower PSA.

Best,

VG

Sw1218's picture
Sw1218
Posts: 65
Joined: Jan 2016

my next PSA is scheduled in six weeks. yes, let's hope it will be lower

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