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What do we know about PSA bounce post RT ?

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Posted 10/23/2013 1:17 AM (GMT 0)
Apparently 12 to 25 % of men who have radiation therapy experience a phenomena known as PSA bounce following the radiation. Apparently it averages around 6 months post RT completion, and could last 2 or 3 yeas.

Unknowns

What causes the phenomena.

How to know if one is experiencing bounce or rapidly rising PSA.

How high the PSA will rise to.

How to determine nadir.

What to expect in terms of final PSA.


Just querying some of you guys who may have experienced bounce. Any informative studies, writings, or anecdotal statements from experts.

Goodlife
Posted 10/23/2013 7:04 AM (GMT 0)
Goodlife,

To my knowledge, a PSA bounce can reach frightening levels. Statistically after about 18 months. This is only noticeable when not simultaneously ADT is performed, which in high-risk Pts. should always be the case. An example:

 

http://www.myprostate.eu/?req=user&id=55&page=graphic

Posted 10/23/2013 2:18 PM (GMT 0)
Hi Goodlife,

Some time ago I came across a PowerPoint slide-deck presentation titled " "Rising PSA post LDR BT - Recurrence or Bounce."

Here's the link:

http://www.prostatebrachytherapy.org.uk/presentations/Mitchell_II.pdf

Not sure if this is exactly what you're looking for, but thought it might be helpful.

Best to you.

Posted 10/23/2013 11:02 PM (GMT 0)
Please confirm statistics on bounce. Ive always been under the impression that all primary radiation patients at some point get the bounce. Is this not correct? Granted my impression was formed from this forum. So is the misinformation yours, not intended if you are wrong, I'm confident of. Or did I misinform my self from mixing dada with dayta?
Posted 10/23/2013 11:11 PM (GMT 0)
I am thinking the same thing as Logo. Was under the impression, that PSA bounce is expected by anyone using RT as a primary treatment. I am assuming (and we know what that means), that you may or may not see a bounce if you having HT at the same time. I do know, that with Salvage Radiation, there is no bounce, and any rise is indication of BCR.

David
Posted 10/24/2013 12:30 AM (GMT 0)
Goodlife,

What kind of a bounce are you having/PSA history? What kind of radiation, and how long after treatment? Salvage or initial treatment?
Posted 10/24/2013 4:01 AM (GMT 0)
Tall Allen et al,

Thank you for your responses. This is a confusing subject, and I am trying to distill all the data and studies down to a list of facts.

Bounce terminology is generally used for Brachy patients, may also be used for primary therapy RT. It apparently only occurs in around 25 % of patients. Usually is seen around 9 months after radiation. If you google it, you will find multiple implications that it also occurs in salvage radiation scenarios, or at least PSA bounce is talked about. That is what prompts this post.

I had surgery in April 2009. Had < 0 results every 3 months for 18 months, then began to see a slow rise to .06 in the next 18 months to .06. My personal trigger with a Gleason 9 PC, was .05 for salvage radiation, in concurrence with Stephenson, of Cleveland Clinic.

I had salvage 7 - 9 of 2012. PSA dropped from .06 to .02, over 9 months. I thought the salvage was successful. At 12 months, it jumped to .05, and at 13 months jumped to .06. Based on historical numbers, did not seem logical, based on historical growth of previous 4 years. Confirming PSA at 13 month ruled out lab error.

So my next question revolves around bounce. Should I expect it, or am I seeing an aggressive reoccurrence ? So. I am still digging for information on post RT bounce.

Any info or studies anyone has seen will be appreciated.
Posted 10/24/2013 9:43 AM (GMT 0)
Goodlife-

I'm so sorry you're going through this anxious waiting for a second time. Truly cruel and unusual punishment.

What does Dr. Stephenson say? If anyone's an expert, he is.

I believe the definition of biochemical failure after adjuvant or salvage radiation is >.2 and confirmed or rising, so yours hasn't failed by that definition. The definitions are not based on or validated for ultrasensitive tests. I haven't seen any definition of a bounce following SRT. I suppose if there were a lot of prostate tissue left post-surgery, it could potentially produce a bounce.

You didn't mention any neoadjuvant or adjuvant ADT, so I assume you didn't have any. I guess your choices are:
(1) wait and hopefully it was a bounce from unresected prostate tissue,
(2) wait and move onto ADT if it becomes a recurrence (>.2), or
(3) you might ask your doctor if it makes sense to start ADT now and take it for a couple of years and then see if that clears it up.

- Allen
Posted 10/25/2013 1:20 PM (GMT 0)
Allen,

I realize my increases are very small, but they are indicative of some activity. I am kind if assuming that if the PSA can bounce for Brachy or primary radiation, it can bounce for salvage, because to the cells that get hit in the prostate bed, it is primary treatment for them.

I am saving Adt for my last gasp. I think I will wait for fairly high PSA, and/or mets before I start it.

Goodlife
Posted 10/25/2013 5:14 PM (GMT 0)
Goodlife,

The big difference is that with primary therapy there is an intact prostate gland left inside that can still put out PSA. Yours has been removed.

ADT is used for several different purposes with prostate cancer when treating with adjuvant/salvage radiation:

(Use #1) neoadjuvant (before starting) and concurrent with radiation: it selectively sensitizes the cancer to the effects of the radiation. Lasts about 2 months.

(Use #2) adjuvant (after finishing) to the radiation: it "mops up" any stray hormone-sensitive cells that are left over and may be in circulation afterwards. Lasts up about 1 1/2-2 yrs for high risk.

(Use #3) after radiation failure: this is long-term use for the rest of one's life, used continuously or intermittently.

I can certainly understand your feeling of wanting to put off Use #3 (what you call the "last gasp") as long as possible. However, Use #2 has a chance of permanently precluding Use #3. Doing two years of ADT now may make it possible that you will never have to do any again. There are no guarantees, but it gives you a shot at it.

- Allen
Posted 10/25/2013 5:19 PM (GMT 0)
Goodlife,
Great meeting with you in Chicago and thank you for sharing your xrays and photos with me on your "kindle". I regret that you have to "revisit" this crap. As one of the least informed members of this forum, I can only offer you my most simplistic take on your situation. I graduated with an "A" in logic and a "D" in religion when a Jesuit priest told me to "take it on faith my son". I don't believe that my reply is printable.
Please correct me if I am wrong:
1. Your prostate was surgically removed.
2. Salvage radiation was done due to an increase in psa hopefully in the bed.
3. Your psa is increasing ever so slightly when there should be absolutely none.
Tall Allen has absolute faith in your doctor as being one of the best and I believe that you have confidence in him also. Many doctors will take a "wait and see" approach, but the decision is really yours. If your doctor can provide you with a reasonable explanation as to why you still have psa in your system, then both of you should agree as to a figure when you will start ADT. I wish ADT on no man, but with an original diagnosis of Gleason 9 I wouldn't wait too long. With all the rods, bolts, screws, and nuts holding your broken bones together is palliative radiation even a possibility if mets ever appear?
I wish you all the best!
Bill idea
P.S. Stay off of cranes!!!!!!!
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