Rebounds and more rebounds (I hope)

I decided to open a new thread with this title since the situation has changed quite a lot. This is my old thread:

Newbie from Spain

I had LDR BT on February 2015. You can see the biopsy results and PSA history in my firm. The complete PSA evolution:


6/1/2006 1.7
6/1/2008 1.2
6/1/2013 3.4
6/1/2014 3.2
10/1/2014 3.7
1/1/2015 5.2 (perhaps not real because of the previous biopsy)
2/23/2015 LDR Brachy
5/18/2015 3.28
9/7/2015 2.22
2/15/2016 1.16
3/31/2016 2.81
7/21/2016 2.44
1/31/2017 4.67

Not a very positive PSA evolution from the Brachytherapy date. With a Nadir of 1.16 this could already be defined as recurrence, but my hope (and belief) is that a really big rebound is happening.

Yesterday I visited the radiologist. He also hopes that this is a rebound, but ordered a round of antibiotics, another PSA test in two weeks, and a Choline PET scan.

What gives me some hope is that with a Gleason of 6 and PSA below 4 before the Brachy, the PSA increase after the procedure is too aggressive to just signal a recurrence.

Your thoughts?

Bololidat said...
A rebound means exactly what to you? I can not figure your post out...it battles its self with words that make no sense in even a poetic way...it seems to use words like rebound and nadir in ways that in a context of treatment are medically inconsistant with the medical description "normally assigned" to same...Sorry I don't get it...others might and if so will comment as to their understanding...

Jejeje It must be that English is clearly not my mother tongue.

Maybe instead of rebound I should have used the word "bounce". As in:

"PSA Bounce After Radiotherapy May Be Associated With Outcomes in Patients With Prostate Cancer"

but it is easy to find other articles where "rebound" is used:

"Elevation of PSA after prostate radiotherapy: rebound or biochemical recurrence?"

To me PSA Rebound and PSA Bounce have the same meaning. Maybe they are not the same according to you?

With respect to the term Nadir, I'll confess that I do not find where I have used it incorrectly.

"The PSA nadir is the absolute lowest level that the PSA drops after treatment"

Therefore my PSA Nadir is 1.16. Or is my understanding completely wrong?

Hope it is just a bounce and will resume its downward trajectory. As you can see, from my signature, I've bounced all over and it took several years for me to come down to where I am today. It was nerve-rattling, to say the least, but the good friends here reassured me. Hang in there.

You have the Nadir correct and you are in a normal timeframe for a "bounce" which usually occurs 18-36 months after the radiation. about all you can do now is watch the trend and determine what is next if the trend continues upward. I agree with your assessment regarding the risk level unless you had some higher grade PCa that wasn't picked up on the biopsy.

Post deleted - Rule 3 Violations.

Post Edited By Moderator (Tudpock18) : 2/16/2017 6:05:36 AM (GMT-7)

Vision, I join the others in wishing you the best and hoping that this is either a bounce or protatitis. Please let us know how it goes.

Jim

You may feel gratified to read this:

/pcnrv.blogspot.com/2018/03/bounces-after-primary-radiation-therapy.html

OK, a new update after one year for all of you that are worried after a really big PSA bounce. My PSA is now down to 0.49 in January 2019 after the last 1.16 reading in January 2018.

I could not be happier!

RT often have the tendency to brush away any increase in PSA after radiation treatment as a PSA bounce. It happened to me twice. In 2011, I had brachytherapy in June 2011 for Gleason 3 + 3 prostate cancer with low volume. The pre-treatment PSA of 3.2 went down to 0.1 in December 2012. During the next year I had a small bounce. Then PSA started rising, first more slowly and then more rapidly. When my PSA reached 1.5 in July 2016, my RT (who performed brachytherapy) brushed it away as PSA bounce. Luckily, I had an appointment with my URO. Who found suspicious spot in DRE and ordered a biopsy. Guess what, the biopsy found extra-capsular recurrence, confirmed by MRI. I had cyber knife with ADT with another RO. My PSA went down to undetectable very quickly and stated that way until January 2018. Then it started rising, 0.2 in April and 0.9 in July. My cyberknife RO said PSA can do strange things. Luckily, I could get a NIH sensitive PET/CT scan study. Scan found metastatic cancer in about 10 lymph nodes. Biopsy of one of the lymph nodes found metastatic cancer. My PSA reached 4.48 in November, when I started ADT treatment with Casodex and Lupron.