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Post-HDRBT PSA Doubled in 3 Months

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Posted 11/23/2018 6:43 PM (GMT 0)
I had HDRBT monotherapy done in Feb 2018. My followup 3-month PSA values are as follows:

5/18 2.19
8/18 2.50
11/18 5.60

My next RO appointment isn't until mid-January (out of town). At my last appointment, he told me that the August value of 2.5 was probably not a problem, but I seriously doubt that he will say the same about the November value. The November value is more than twice the August value (<3 month doubling time), and is higher than at any time prior to my HDRBT procedures.

I was wondering if I should ask to have this PSA test redone before then, just in case it is erroneous. Also, is it time to start pushing my local urologist (appointment on Dec 13) for a bone scan and PETscan to look for metastasis? This new reading has me freaked out and I'm not sure what to do or expect from here.

Any feedback would be greatly appreciated.

Jim
Posted 11/23/2018 7:10 PM (GMT 0)
Might be a good idea to have a retest before then. Unexpected results should be confirmed.

While it's possible it's just an RT bounce, it is a big jump that you shouldn't have seen.

Do keep us updated on your progress.

Andrew
Posted 11/23/2018 7:11 PM (GMT 0)
I would definitely as for a retest. Now. Beyond that, I’m not sure that I’m qualified to answer. It seems like 5.60 is too much to be a PSA pounce.

I’m guessing an Auxumin PET scan should be done if the 5.6 proves to be real. But again, I’m no expert, others with more knowledge will respond soon
Posted 11/24/2018 12:25 PM (GMT 0)
I'd retest.
Looking at your stats, it seems unlikely to me that the increase, if real, results from cancer, especially metastatic. You're a Gleason 6, confirmed by Hopkins, and an MRI shows you're unlikely to have EPE, and your PSA was lower before treatment than your latest. For this increase to be cancer related seems highly unlikely. In fact, if you had not been treated at all it's unlikely your PSA would have increased as much.
It could be a benign bounce (common occurrence), but it's a bit on the high side for a bounce but possible (mine doubled). I don't see that you have a history of prostatitis, but that would be my bet, assuming it's not an error, unless you had sex before the PSA or a long bike ride. Could be prostatitis and a bounce at the same time.
I'd call my RO and have this discussion and not drive myself crazy waiting until mid January.

Best wishes.
Posted 11/24/2018 4:47 PM (GMT 0)
ITS, Pratoman and HR, Thank you all for your feedback. I have been having some UTI-type symptoms lately, so just in case it may be related to prostatitis, I went to the walk-up clinic today and had my urine tested. All results were negative. I'm going to contact my urologist Monday to get a PSA retest done. If those results come back similar to the original test, I'll try to move my RO appointment up. Trying to generate a discussion of any issue with the RO or his staff by phone is quite problematic (frustrating), so any discussion will probably have to wait till we're face to face.

Jim
Posted 11/24/2018 5:04 PM (GMT 0)
Even though it seems high to be a bounce, I would bet it is. I would retest to rule out lab error and then get another test in 3 months. I highly doubt if the value represents cancer since it is higher than your pre-treatment value.

Paul
Posted 11/24/2018 5:28 PM (GMT 0)
A UTI or prostatitis can raise PSA, even post RT if you still have a prostate. You might want to give it a month or so before a retest so things can recover a bit.

If you suspect a UTI, you might contact your URO if you can get in there faster - to help with any UTI/Prostatitis.

Andrew
Posted 11/24/2018 5:37 PM (GMT 0)
I doubt I could talk with my RO directly either, but I have on occasions called his nurse and she has asked him questions on my behalf and then relayed his answer to me.
Make sure to say how extremely troubled you are over the PSA result and your next appointment isn't until January.
Posted 11/25/2018 10:31 AM (GMT 0)
I hope it is a combination of bounce and prostatitis. I poked around looking for studies and found a couple that said a third of us will have a bounce and the median time is 9 months after treatment. However, the level of the bounce I think was about .5 on average. I am sure this is a scary time for you, hang in there. Denis
Posted 11/25/2018 12:07 PM (GMT 0)
Jim I hope the PSA jump is nothing. If it is I am sure you will deal with it and get on with life. Here is an interesting article on the subject. https://prostatecancerinfolink.net/2017/01/14/nadir-psa-predicts-survival-after-radiation-and-androgen-deprivation-for-unfavorable-risk-patients/ Best wishes!

69 yrs., marathon runner with knee injury, 41 of 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.
Posted 11/25/2018 4:24 PM (GMT 0)
Everyone, thank you for your encouraging words and information. Hopefully I'll have a clearer understanding of where I really stand on this issue in the next few weeks.

It's been a rough couple of years for me. Colon cancer with right hemicolectomy performed and now followup monitoring. Prostate Cancer with HDRBT performed and now followup monitoring. Hospitalized for 5 days for sepsis from the last HDRBT procedure. Multiple potentially malignant side branch IPMN pancreatic cysts discovered during sepsis hospital stay, now going through extensive imaging, endoscopic and ultrasound evaluations and followup monitoring.

Needless to say, it's been quite a stressful time. The more of these I get, the worse the odds are of all of them having successful long-term outcomes.

Jim
Posted 11/25/2018 4:41 PM (GMT 0)
Jim another way tolook at it is you are due some good news!
Posted 11/25/2018 6:00 PM (GMT 0)
This is definitely not a radiation bounce...your latest PSA result is (appears to be, unless I misread) your highest ever.

Mets is highly, highly unlikely, and definitely not worth looking into now.

Your pretreatment PSA was so low (you treated a Low-Risk case, right?) that possible prostatitis will be difficult to distinguish...but this appears to be a likely contributor.

Last on the list but less likely is test error.

Acting on Low-Risk cases introduces guys to the “slippery slope.” Not your “fault,” it is what it is.

Post Edited (Blackjack) : 11/25/2018 11:03:30 AM (GMT-7)

Posted 11/25/2018 6:27 PM (GMT 0)
Thank you for your input, Blackjack. So how would I determine if it is prostatitis? I just had my urine checked for UTI, and it came back negative. Should prostatitis show up in a urine sample? If not, how do they detect it and treat it? If not detected somehow, will the urologist just prescribe a round of antibiotics "just in case", then retest the PSA afterwards to see if it helped?

Denis, thanks for the positive words. It's good to see that your PSA is behaving so well! I had my procedures done two weeks after yours, by the same RO at FH.

Jim
Posted 11/26/2018 10:36 AM (GMT 0)
Jim talk to the RO, as you know an easy guy to talk to. Keep us posted. Denis
Posted 11/26/2018 3:34 PM (GMT 0)
No doubt the amount of the jump concerns you. And it must be followed up with a retest, etc. However, first of all some bounce around is expected with RT, and more importantly: you still have a prostate. Which means you have all of the usual suspects when it comes to sudden increases in PSA. Remember, at these early stages, a sudden big jump in PSA is not normally caused by the PCa, Y'all correct me if I'm wrong. Just like before treatment, if youhad come here and told us your PSA suddenly doubled or tripled in some short period of time, most would tell you that it was probably not PC, more likely BPH/prostatitis, bike riding or that wild session of sex that you had 1 hour before the test.

I am an RP guy, and a while back after being pretty stable with a very slow rise, mine TRIPLED in 3 mos! But then it did not increase at all during the next year or so, even went back down a tiny bit. Turns out they had just got some new machines with a higher bottom limit, and a lot of folks showed a sudden increase.

Lastly, just something to consider: dying PC cells dump their PSA into the blood stream. So, who knows where the extra PSA is comong from? Right now, no one knows. Obviously, you wll be watching it closely, but don't panic just yet! ;)
Posted 11/27/2018 12:32 AM (GMT 0)
VeroJim,

If the PSA is higher than pre-treatment value, then it is not bounce. I was treated for Gleason 6 cancer in 2011 with seed implant. Then an extra-capsular recurrence was treated with ADT and Cyberknife in 2017/18. This year my PSA rose from undetectable in January to 1.3 at the end of August. A PSMA scan in October found metastatic prostate cancer in nine or ten pelvic lymph nodes. My PSA on October 4 was 1.8, on October 22 was 3.26, and on November 16 was 4.48. I have just started hormone treatment with Casodex and Lupron.

If I were you, I would have another test without any delay and then see an MO if the rise in PSA is there.
Posted 11/28/2018 9:55 PM (GMT 0)
My urologist agreed that my latest PSA reading was quite odd. He has prescribed 3 weeks of antibiotics for possible prostatitis, then a PSA retest. Hopefully we will have a better idea what's really going on after that.

Jim
Posted 11/29/2018 1:53 AM (GMT 0)
Sounds like a good plan
Posted 11/29/2018 4:47 PM (GMT 0)

VeroJim said...
.....He has prescribed 3 weeks of antibiotics for possible prostatitis, then a PSA retest...
Jim

A good plan as long as it's a relatively mild antibiotic...you don't want 'black boxed' Cipro. It ripped me up and caused C. Diff. Not fun!

The RO you used is very good at what he does. But his firewall communications are a real turnoff. Good luck!
Posted 12/27/2018 6:59 PM (GMT 0)
Well, the initial antibiotic approach didn't work out too well, as I found out that I was allergic to Bactrim DS. It didn't show up at first - it took 9 days before having to go to the emergency room with a severe rash all over my body. This was quite a surprise, as I have never before in my 69 years had an allergic reaction to any medicine, including other Sulfa drugs. The Urologist then switched me over to Macrobid, which I was able to tolerate without further incident. After all of that, I had a PSA retest, resulting in exactly(!) the same PSA level (5.60) as my previous test results.
My local urologist was unwilling to take any further steps based on these new results, saying that I needed to first review this with my RO in Orlando.

I was finally able to contact my RO's staff by phone today, and they decided that I do indeed need to have an Axumin PET scan done. We're in the process of scheduling that now, and I will post the results of that here when it is completed.

Jim
Posted 12/28/2018 2:32 PM (GMT 0)
I have to say I’m surprised at the RO’s scheduling of a PET scan. OTOH, I suppose it’s better to be proactive in these cases than not.
Looking at your signature, seeing Gleason 6’s, confirmed by Epstein, followed by a mp-MRI showing no other suspicious areas and no evidence of EPE, I’d say you were a good candidate for AS, yet you had treatment. Your chances of having metastatic prostate cancer should be remote at worst and practically impossible at best according to all I read. If it is the worst, than it’s a sad commentary for all we think we know about this disease and for mp-MRI’s. If I were an AS guy, it would make me rethink my decision.
I cant imagine they’ll find anything. I pray they don’t.
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