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PSA results 1 yr after SBRT

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Posted 12/19/2017 5:28 AM (GMT 0)
Hello everyone it's been awhile since I've been here and my husband and I did visit Dr Zelefsky at MSKCC back in September for his 1 year post SBRT checkup. He is still without any side affects and doing well. He does have some occasional ED but he is reluctant to try any meds so we continue to have that discussion. Dr. Zelefsky said his prostate feels smooth and regular in size so he does not need to come back in 6 mos but to just get his PSA and T checked locally and send him the results. He does have to come back though in Sept of 2018 for another Fusion Biopsy to see if any PCa can be found. If clear then we don't have to come back for 5 years but still will need PSA and T testing. On a side note, my husband just had his colonoscopy and his GI MD said he did indeed notice the area of the rectal tissue that received the radiation but was surprised how small of an area it was. He said he has seen his share of radiated rectal tissue and this is by far one of the mildest.
Since his SBRT here are his numbers for
PSA and T: 3.20,755; 1.60,735; 1.80,624; 1.10,628(*we are happy about this latest one)
My husband and I worked on this chart of his PSA data. Looking back I think how ignorant we were about PSA numbers. We had no idea that therapy probably should have started earlier than they did. What strikes me about the chart is how dramatically things changed after SBRT. I do hope the chart pops up. My best to all. VIEW IMAGE
Posted 12/19/2017 6:06 AM (GMT 0)
Chart looks good. He seems to have been treated at a good time - not too soon, not too late. A biopsy? Is that because this was part of a clinical trial, or does MSK do that with all their radiation patients?
Posted 12/19/2017 6:51 AM (GMT 0)
No clinical trial. Dr. Zelefsky just stated that after one year of good results a followup fusion biopsy will be done to rule out any more cancer. I would like to hear from others what their post/SBRT protocol is.
Posted 12/19/2017 7:28 AM (GMT 0)
I just had PSAs and T levels checked. But I was GS6 - nothing would've shown up on an mpMRI anyway. I've never heard of post-RT biopsy outside of a clinical trial, or if there's been a PSA recurrence. I don't really see the point, and I don't think I'd want another biopsy - 3 in one lifetime is enough for me.
Posted 12/19/2017 1:25 PM (GMT 0)
The post-treatment protocol Dr. Hirsch (suburban Chicago) is following for me is that we did quarterly PSA and T reads for the first year, with office visits each quarter. Now, for the second year, we are still doing blood tests quarterly, but only having office visits every 6 months. I feel like I've been released back to my "regularly scheduled life."
Posted 12/19/2017 4:54 PM (GMT 0)

Tall Allen said...
I just had PSAs and T levels checked. But I was GS6 - nothing would've shown up on an mpMRI anyway. I've never heard of post-RT biopsy outside of a clinical trial, or if there's been a PSA recurrence. I don't really see the point, and I don't think I'd want another biopsy - 3 in one lifetime is enough for me.

If it were me, I would respectfully refuse the biopsy. As an excuse, you, or your husband, could mention that you don't like the (admittedly small) risk factor.

Post Edited (Sr Sailor) : 12/20/2017 12:48:06 PM (GMT-7)

Posted 12/19/2017 10:01 PM (GMT 0)
Thank you for the input, I am going to discuss this with my husband. Do you think it has anything to do with that PIRADS 5 on the MRI he had?
Posted 12/20/2017 6:13 AM (GMT 0)

InquisitiveOne said...
Do you think it has anything to do with that PIRADS 5 on the MRI he had?

Could be. Maybe Zelefsky knows something I don't - which would not be at all surprising - he's the man! I've never seen a study about biopsying without cause after radiation. (I have seen studies where they biopsy after ablation - but that has different issues)

Considering that it may take years for all the cancer cells to die completely, I don't know anything at all about what to expect from an mpMRI or a biopsy a year after treatment. All kinds of questions come to mind:
• What is expected on an mpMRi? I mean, should the PIRADS be reduced or go away entirely? Is reading PIRADS different for irradiated tissue? What is its negative and postiive predictive value? Does MSK have someone with experience in reading irradiated tissue?
• How do they distinguish, on a biopsy, cancer cells that are viable from the ones that have double strand breaks and are waiting to die?
• Do they have someone with experience in reading Gleason scores on irradiated tissue?
• If any cancer cells are viable, can the biopsy spread the cancer?
• Is a biopsy more prognostic than just tracking PSA?
Posted 10/21/2018 11:24 AM (GMT 0)
Hi InquisitiveOne-

Hope all is well.
You may recall I too was treated by Dr. Z in 2016 and was very pleased.
I am now coming up on two years post SBRT with declining PSA's and Dr. Z is suggesting a follow up bx as he did with your husband.
He states that it is part of his protocol at MSKCC.
I am not fond of the idea of doing this in view of falling PSA levels and was wondering how you handled this ?
Thanks
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