1st PSA higher after SRT. Failure? What next?

Tomson -

Allen will likely be along to tell you more.

From Allen's previous posts on this subject PSA will initially go up as the radiation kills the cancer and the cancer cells send their PSA into the bloodstream.

Rooting for you!!

Bobby Mac

PSA after RT takes forever to come down. An upward rise, while annoying, doesn't mean much at three months. In fact it might be a good sign. You'll have to wait for the six month test to confirm.

Here's the deal: When radiation kills a PC cell, that cell releases all of it's PSA into your blood. Your body will flush that out in time, but killing a large number of PC cells can, in the short term, raise your PSA. It could be that a bunch of PC cells just died, raised your PSA and anxiety level.

Also, post RT PSA can be a bit bouncy until it finally settles down.

Do talk to your RO, but I think you'll find you're in waiting game now.

Andrew

Really, what else can you do but wait 3 months for the next test?

As always, it's great to have good companions on this journey.

TA asks what else can I do besides wait another 3 mos? From a clinical point of view, apparently nothing. From TA's response, I gather it is not worth seeing a medical oncologist nor would I qualify for any clinical trials so early in the game. In a way, that's reassuring as I can certainly use another 3 months of good health in which I can enjoy riding my bike in the hills, doing yoga, reading and writing, and remaining active in my community. However, I am a curious person so I keep reading medical journal articles and trying to figure out what's happening to me. I am interested in understanding the science even if there is no next step to be considered at this time so I ask questions.

RobLee asks whether I was on HT. My RO did not recommend it. He is one of the authors of the recent paper that showed it to be advantageous, but he said I was in a subgroup that did not appear to benefit.

David mentions my "pesky" tert 5. That's how I think of it, too. Both tert 5 and PNI are getting bad reviews these days. Whether either of these has any connection to my relatively early BCR after RP is one of those things about which I am curious. Did tert 5 cells sneak down my nerves and escape into my bloodstream? So much more will be known about PCa in five, ten years!

George said...
A PSA value of 0.129 is way too low for a Ga68-PSMA PET/MRI.

George,

I agree. I have no idea why my urologist's team ordered the Ga68 PET/MRI before they would refer me to an RO. The Ga68 test delayed this referral by several months. All told, it took UCSF 11 months to begin SRT after the first reappearance of PSA (.031) in February 2016. I understand that some practitioners would have begun radiation earlier. I don't know whether waiting for a PSA of .2 is standard operating procedure at UCSF, but that's how it turned out for me.

In my case, the SRT was directed to the prostate bed only. My RO did not think the side effects worth the risk of side effects. He said there had been no randomized trial that had shown a benefit to lymph node radiation in the post operative setting. The lymph nodes are right up against the bowel so chances of side effects are much higher than with SRT to the prostate bed alone.

Tomson

I had no PSA increase during my SRT.

In fact, halfway thru my SRT I had a PSA test done and my PSA dropped by almost half (from .07 to .04). It has remained undetectable since.

Bob said...
75 grays/50 sessions to all pelvic lymph nodes

Wow. Didn't know you could take that much further radiation to pelvis after SRT. My RO decided not to fire away at the lymph nodes along with the pelvic bed.

I'll let everyone know what he says on Thursday. Best guess: "Have a nice summer and we'll talk after you get another PSA test at the end of August."