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Posted 7/19/2016 8:35 PM (GMT 0)
Today I had my 3rd PSA test since completing Proton Therapy at UFPTI in January 2015. When I began the treatment my PSA was 11.2 and has fallen nicely to 1.28 last January. My hope today was another 50% reduction but I would have been satisfied with anything under 1.0. When the doctor told me it was 2.66 I almost fell off the table. My worst fear realized.

I know it could be a lab error, PSA bounce, prostatitis, or recurrence. I immediately told the doctor I wanted another blood sample drawn and sent the the lab today just to double check. This is the same lab I've been using for 15 years.

I'm not sure what the definition of a bounce is. Can it be as much as mine increased? Doesn't prostatitis usually increase more dramatically than mine did? I will notify UFPTI of course tomorrow, but in the meantime anyone have encouraging words for me that can talk me off the ledge?
Posted 7/19/2016 8:49 PM (GMT 0)
Bounces are common, and are often prognostic for a lasting cure. This is a long game. You can't react to every bounce like this (I've had 3) or you'll drive yourself crazy. Adjust your expectations, and view each PSA test as just another data point along the way.
Posted 7/19/2016 9:01 PM (GMT 0)
Me thinks your pretreatment PSA was not cancer. Duke couldn't find any. The jury was out on whether there were any 4's to begin with (with the best of the best seeing nothing but a smidgen of 3's).

24 core biopsy. 1 needle at 5% of "if 4's, barely 4's". Whatever was putting it out before still is.. or.maybe it is a bit of a bounce. Just doesn't seem like there was enough to begin with to cause much of a bounce.

I don't believe it's recurrence. It being that difficult to dine Amy pretreatment one would think it's be almost impossible to find any post treatment. One man's opinion.
Posted 7/19/2016 9:47 PM (GMT 0)
I see a bouncing PSA.

and more anxiety for you.

Hang in there,
Andrew
Posted 7/19/2016 11:19 PM (GMT 0)

Tall Allen said...
Bounces are common, and are often prognostic for a lasting cure. This is a long game. You can't react to every bounce like this (I've had 3) or you'll drive yourself crazy. Adjust your expectations, and view each PSA test as just another data point along the way.


I know they're common, but do my numbers qualify for a bounce? I thought most bounces were just a few points, e.g., 1.0 to 1.2 or .6 to .7. Mine went from 1.28 to 2.66.
Posted 7/19/2016 11:59 PM (GMT 0)
I biochemical recurrence is nadir+2. A bounce is anything less.
Posted 7/20/2016 3:42 AM (GMT 0)
TA, Allow me to ask a naive question.

If treatment is something other than radical prostatectomy, then I would assume that the prostate gland is still intact, but with the cancer lesions eradicated. So, why would there not be the usual benign psa fluctuations, as any older non-PCa-man might have?
Posted 7/20/2016 5:54 AM (GMT 0)
After a while, the healthy cells become "fallow" and start to atrophy. The prostate shrinks and hypertrophic (BPH) calls disappear.

As cells die, they release PSA into the serum. Healthy cells die or self-repair pretty quickly. Some cancer cells die immediately too, especially the more rapidly growing ones. But some don't immediately explode, and because cancer cells don't self-repair, they only officially die when they try to reproduce. I say "officially" because in reality, they are incapable of surviving the double strand breaks (unlike healthy cells). They go into a kind of hibernation when they are injured and that can last for years. But when they try to divide, they are destroyed. But eventually they die and release PSA.

Because the rapidly multiplying aggressive cancer cells are most readily killed by radiation, it may be that a quick drop-off in PSA connotes a more serious disease, while a slower drop off, with bounces, connotes less aggressive disease. Less aggressive disease --> better prognosis. It's just a theory.
Posted 7/20/2016 8:39 AM (GMT 0)
Earlier PSA Bounce After Radiation Therapy
The first PSA bounce after radiation therapy was identified at 17 months (95% confidence interval [CI] = 15–18 months). This finding was in contrast to patients who experienced biochemical failure; for them, the median time to a first PSA bounce was 41 months (95% CI = 28–53 months). In total, 33% of patients experienced at least one PSA bounce. The median magnitude was 1.0 ng/mL (range, 0.4–17.0 ng/mL). Patients 70 years and older were more likely to have a PSA bounce. On multivariate analysis, the sole identifiable predictor of a likely PSA bounce was a Gleason score of 6.
Closing Thoughts
Experiencing a PSA bounce was associated with improved biochemical disease-free survival. A PSA bounce occurred sooner after radiotherapy than a recurrence of prostate cancer.

Source: PSA Bounce After Radiotherapy May Be Associated With Outcomes in Patients With Prostate Cancer
By Joseph Cupolo
Posted: 10/1/2014 12:47:40 PM


The questions I have about this are why would the men in the failure group not have a bounce until failure? Even though they evidently had some undamaged cancer cells remaining after treatment, it would seem that most were damaged and would cause a bounce just like the men the other group. And does biochemical failure usually take 4-5 years after radiation to present?
Posted 7/20/2016 9:30 PM (GMT 0)
I know it is difficult, but keep positive. Bounces are quite common after primary radiation therapy. I know that when you are going through it, it feels like it is going to be bad news. I had my bounce at 24 months and was very concerned. I hope that it is nothing more than a nerve racking bounce. Hang in there.
Regards,
Kris
Posted 7/21/2016 12:15 AM (GMT 0)
Thanks everyone for the reassuring words. Based on all I've read and searching through pages of previous HW posts on PSA bounce, I feel it's likely that my increase is a bounce. It's much more common than I had thought. Many of the guys here have had them and as I read through their history I can only imagine how difficult it was for them to wait 3 moths for another test only to find PSA up again and have to wait another 3 months. Many waited for 36 months or longer for a drop below 1.0. As TA said, it's a long game.
Posted 7/21/2016 12:27 AM (GMT 0)
You got the flick.... sumpin we used to say when transfering responsibilities from one controller to another in ATC...loved that fricken job....
Posted 7/21/2016 1:39 AM (GMT 0)
My physician suggested taking ibuprofen or naproxen for 3 weeks prior to the next PSA test. He had anecdotal and a few case reports of NSAIDS reducing the PSA bounce. I will never know if the they worked or not for me.

Thanks
Paul
Posted 7/21/2016 10:14 AM (GMT 0)
Paul, your history was one of the several that I cut and pasted to a Word doc as I compiled a record of the many HW brothers who had experienced the dreaded "bounce". You ticked up in Nov 2012 and it took 9 months for you to get back to your Aug 2012 level. Then you were jerked around again for another year. I'm sure you're glad that's over. It was very helpful for me to see your history and many others. Thanks to all for keeping them updated.

If I had known as much about bounces and that prostatitis could return after treatment, I might not have had radiation. It takes a person who can manage uncertainty and apprehension much better than I to go through this for 3 years.
Posted 7/21/2016 12:34 PM (GMT 0)
Paul, I keep a supply of diclofenac on hand for occasional arthritis or inflammation from excessive exercise. I will try the 3 week regime before my next PSA test.
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