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Can Rise in PSA be Due to Prostatitis?

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Posted 9/15/2018 12:36 AM (GMT 0)
After my brachytherapy in 2011, my PSA dropped to 0.1. Then between 2015 and 2016 it rose to 1.8. Second biopsy in 2016 found cancer in extraprostatic mass. ADT and cybeknife brought the PSA down to undetectable, which stayed there until April 2018. Then it started rising very sharply: April 6: 0.2 , July 13: 0.9, Aug 28:1.3. My question is can this increase be due to prostatitis. Only symptom I have is slight occasional burning during urination, which may due to radiation treatment. My prostate size has remained small after brachytherapy.
Posted 9/15/2018 12:55 AM (GMT 0)
just a thought, maybe you should try to look for a PET scan of whatever is the latest/best.. they could have missed on some mets,, wouldn't prostatitis be very painful and have more symptoms? Ed
Posted 9/15/2018 3:21 AM (GMT 0)
It could be a post RT bounce. Happens sometimes.
Posted 9/15/2018 9:36 AM (GMT 0)
I dont know how long it takes for the effects of ADT to wear off. Your PSA was certainly reduced by the effects of the drug early on and would start to climb to its natural state after you stopped in April, 2017. My guess is your PSA is no longer influenced by the ADT. Three consecutive increases of PSA used to be considered BCF after radiation but now it's generally accepted to be 2.0 over nadir. I would doubt that the increases are causes by prostatitis. The increases are too small and sequential. What does your RO think?
Posted 9/15/2018 11:51 AM (GMT 0)
The criterion 2.0 over nadir may not apply to me for the following reasons:

1. My PSA nadir was 0.1 after brachytherapy. When it started rising, before it reached 1.5 I had a large 1 inch diameter extraprostatic cancer emanating from the capsule.

2. No cancer was detected inside the prostate. It should be producing very little PSA.

3. After ADT and cyberknife my PSA remained undetectable for a year.

4. Since only the extraprostatic mass was radiated, there should be no PSA bounce from the prostate.

5. My pre- ADT cyberknife PSA was 1.8. Is it possible to have a bounce that goes over this value?

My URO seems to agree that I have a recurrence with a very short PSADT. He has given me a prescription for Axumin PET/CT scan, which I will get done on oct 12. I am yet to see my RO.
Posted 9/16/2018 4:02 AM (GMT 0)
Get the scan. Not sure your RO can do anything more for you, but a consult might be in order.

I wouldn't expect to find prostatitis after RT. A UTI is possible, but a consistently rising PSA is always worrying. Hopefully the scan can help locate where it might be coming from which will give you more info. Sadly if it really is recurrence, I' afraid that its back to ADT as your treatment.

Andrew
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