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New Member, Pre-Treatment

DuginMT
Posts: 2
Joined: Feb 2021

Hello all.  A brief background: my PSA started climbing from around 2.0, three years ago, to 4.7 now.  I've had two 12-core biopsies, about a year apart.  I wanted to try active surveillance and supplements.  The first showed 5% cancer in one core.  The second showed 5% cancer in one core and 20% in another.  Both Gleason 3+3.  I'm 57.  Prostate size is 20 CC.  I have no significant symptoms, and am glad it appears to have been caught fairly early.  I've decided on Cyberknife treatment here in my home town.  I don't want to go through the next 15-20 years getting regular biopsies, wondering if the cancer has spread or grown, and possibly getting symptoms.  Last week, I had the 4 gold fiducial markers installed.  Next week I will be getting the preparatory CAT scans and MRI.  Hoping to get the Cyberknife treatment in a month or less.

My urologist said, "don't let anybody sample you for PSA within 5 months of radiation".  So, I will be going in for a PSA test in about 6 months.  I realize that Cyberknife treatment will turn my prostate into mostly scar tissue - but it is not being removed entirely, so I would expect some residual/baseline PSA number.  So after Cyberknife treatment and a wait period of 5 months, what should I expect my PSA number to be, and what would be a cause for concern?  Assuming my treatment is successful, should my PSA stay within a fairly tight range the rest of my natural life?

Thanks!

Old Salt
Posts: 788
Joined: Aug 2014

Congratulations on making a decision and moving forward with SBRT. 

Yes, you will need to have PSA tests at regular intervals. The first one should show a drop from your current level of 4.7 ng/ml. How much down is anybody's guess. Further testing will be at your radiation oncologist's preference; initially once every six months is common. But don't be afraid to sample more frequently. Hopefully your PSA will continue to drop over time. At some point in time your PSA should reach a nadir (minimum), but there will be bounces along the way. They tend to make the patient nervous (I was!). 

Only when your PSA rises to nadir + 2 is there reason for concern. Let's hope that won't happen.

In case you are wondering, I did receive SBRT as part of my treatment; my case was a lot worse than yours (several sites with Gleason 9 and a PSA of 12 or so). After seven years, my PSA appears to have 'stabilized' around 1.4 ng/ml.

Clevelandguy
Posts: 658
Joined: Jun 2015

Hi,

I second what Old Salt said, goods luck on you treatments and hope for very little side effects.

Dave 3+4

DuginMT
Posts: 2
Joined: Feb 2021

Thanks Old Salt and ClevelandGuy!  I too am hoping for minimal side effects.  What side effects from SBRT did you experience?  I've read where they are pretty minimal with Cyberknife.

Old Salt
Posts: 788
Joined: Aug 2014

YOu should discuss the use of SpaceOAR with your radiation oncologist.

SpaceOAR Hydrogel | Prostate Cancer Pre-Treatment Option

THis material is inserted (between your rectum and prostate) to lessen radiation damage in that area. This material wasn't available when I was 'cooked', but my radiation oncologist told me that he now uses it. Nothing is perfect, unfortunately, and side effects have been noted with SpaceOAR.

When I had treatment, the rad oncologist told me that I might have problems urinating, more so after the second or third SBRT session. He gave me a prescription (alfuzosin, I think, but I did not need it. YOur mileage may vary, of course. There are other, similar, drugs for this; just follow your doctor's advice. I was also told that I would be tired; more so after the second or third session. True enough, but not a major issue.

There are also potential late side effects with SBRT. These may result in bleeding from the lower area of your colon. Often this will go away by itself, but if this does happen, consult your rad oncologist right away for advice. 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3609
Joined: May 2012

Welcome to you, Dugin.   Cyberknife is a good choice, with excellent success rates.   It is a brand-name for a form of SBRT technology.   Varian True Beam is essentially identical.  Some hospitals buy one system, some the other.

Like any form of RT, after treatment you will have PSA Bounce.  This will last many months, up to a year or, in some cases, longer.   Your R.O. will monitor this closely, and know what to make of it.   There is no arbitrary "what should my number be in six month" figure available here, or anywhere.   Just know that the proceedure is sound and very effective.

max

mstoriop
Posts: 42
Joined: Dec 2016

Hello Dugan.  Best of luck with your upcoming Cyberknife procedure. You've made the hardest decision which is what you have decided for a treatment path.  I am 3-1/2 years removed from my last Cyberknife procedure and luckily have had very minimal effects so far.  You have already received good opinions above so I cannot offer much more.  I can confirm, as Old Salt said, my Doctor will not worry at all unless my PSA would jump 2 whole points.  Also there is no baseline for PSA regression as we are all different.  For a sort of reference point I was at about 4.7 before Cyberknife.  At 6 months I was at about 1.3.  Since then it has dropped to .3 for about a year and now is .1.  I have not had a bounce yet but who knows.  Best of luck once again I'm sure you will do very well.   

VascodaGama's picture
VascodaGama
Posts: 3320
Joined: Nov 2010

Dugan,

CK's protocol in some clinics involve hormonal manipulation (ADT) which would mask the PSA making this unreliable to certify RT success.  If you have or will be subjected to this combination therapy then the PSA at 6 months may not be so important as you predict. 

A CK survivor have posted here before informing that his PSA bounced during 4 years before he saw it dropping to a nadir below 0.45 ng/ml.

Here is  one of his posts you might see it interested to read.

https://csn.cancer.org/node/302161

Best wishes and luck in your journey. 

VG 

lighterwood67's picture
lighterwood67
Posts: 285
Joined: Feb 2018

Good luck on your journey.  You are certainly getting some excellent info.  PC is not an easy beast to deal with.  Looks like you have made a treatment approach, which in itself is a major step forward.  I was diagnosed in 2/2018.  Gleason 4+3=7.  I went with a surgical approach.  Anyway, this is not about me, but about you.  Good luck.

Deadstick
Posts: 5
Joined: Jan 2021

DugIn,

Just so it doesn't go unsaid, you should talk to your Uro about how your treatment will affect your ability to be intimate in the short and longer term.  No matter the treatment for prostate cancer, there are side efffects that can be be significant. The sooner you start a rehab program, the better off you will be.

 

The best to you...

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