Increasing PSA 5 years after treatment

HI everyone, I had Proton therapy of 38 treatments to 81gy dose ending in August 2009. To start with I was 4+3=7, PSA 3.5 and T2a staged. MRI and Cat scan And Bone scan showed most likely contained in the prostate.

My PSA steadily declined for 2.5 years and reached .2 and stayed there for 18 months and then went to .4 which stayed for 18 months and just rose to .5. I don't believe this is bounce. When I saw my Proton Doc after 18 months of PSA @.4 he said it was almost becoming the norm although I believe he meant he had seen it before. I freaked when I got my latest test @.5. All PSA tests were done at same lab from the start. Proton doc does not seem overly concerned and said test in 6 month and hope it doesn't go up.

Got a Second opinion from a University based well known Pca Oncologist. He said i probably had biochemical recurrence of the cancer and while there is no emergency, I should get a biopsy and if negative, do nothing and if positive do Cryo. I am not in a hurry for another biopsy but maybe I should not screw around and get it done.

What do you all think? Has anyone heard of or seen this type of PSA rise after 5/12 years that was not a problem ie it went down or just stabilized long term? And on the contrary, has anyone seen this and had it keep going up to where the disease had probably returned? Hope all that makes sense. I have seen some old posts where people were looking for salvage therapy after proton therapy. But my search didn't show details of PSA increases and those were old posts.

Thanks in advance................bob

HI Tall Allen, thanks very much for the reply.
Of course you told me what I wanted to hear but I always play devils advocate.
There are a number of methods of determining Biochemical recurrence for radiation which I am sure you know more about that I do. The most often cited version is 3 consecutive increases after Nadir OR PSA of 2.0. My proton doc uses PSA of 1.5 instead. I have seen some definitions of BCR as 2 consecutive increases and some with just an absolute PSA of 2.0. The most common one I have seen is the first mentioned above based on American Society for Therapeutic Radiology and Oncology.
Bottom line on all of these guidelines seems to be that a number or docs get together and come up with what they think is most reasonable based on studies and their experience. None of it certain as i see it.

Given I have had 2 consecutive increases ( or did i, they stayed flat for 18 months before they went up**) I am just trying to get ahead and check out my options should the next one come in higher. Non of the options look good to me.

Actually this Pca Doc is pretty well recognized in literature, practice and teaching and was using the definition of two consecutive increases. I have a functioning prostate for sure and I know it produces PSA but I have had no signs of radiation proctitus ( when you say blood, do you mean in urine or semen) and I was on a course of antibiotics for 2 weeks for a sinus infection before the last PSA test. Alan, thanks again for your response, I have been off this board for years assuming I was done. Maybe I am and Maybe not.
Anyone else have thoughts?

** What defines consecutive increases. My PSA stayed at .2 for 3 consecutive 6 month tests and then went to .4 for 3 consecutive 6 month tests and went to .5 six months later. Depending on what consecutive means, I have only had one increase or two. . If you get an increase then no increase for a while do you start over? Not clear on this at all and I can't find a definition

Alan, thanks so much for taking the time to set that straight. That clarifies all the things i saw on the internet and puts everything in perspective. So now I know the phoenix definition is the correct or most up to date definition. FWIW The Proton center told me three consecutive increases in PSA over Nadir would be considered BCR, at the end of my treatment but that was 2009. They must have revised that because my doc seems to be stuck on a PSA of 1.5 before he gets alarmed. Still he doesn't want to see it go up during routine testing. I haven't stayed up to date obviously, cause I never considered a relapse of Pca after treatment. After seeing the numbers from various studies, it looked like BCR was pretty high for radiation. Even Loma Linda showed some high numbers but it was an old study that contained a lot of lower dose patients. Still, I got real concerned after my PSA went up.

MOST IMPORTANT, your experience with blood in the semen as an indicator of prostatits is exactly what I have experienced a number of times since treatment. Maybe you didn't freak, but i sure did when that happend. I called the doc and he said "radiation prostatitis". It always went away without antibiotics. I had to use Levaquin for this sinus infection ( a 30 year chronic problem and we rotate meds and do cultures) so I thought that would rule out Prostatitis as a cause. Maybe not given your comments on non response to antibiotics. Thank you again for your comments and help on this, think I will relax a little.Also, I asked my proton doc what they have seen for BCR and he said so far, 2-3%. those numbers sound good to me....best, bob