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Alarmed by new PSA 1 year post SBRT

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Posted 12/9/2018 3:03 PM (GMT 0)
Hi Folks-

I had SBRT at MSKCC in Feb 2017.
Original PSA was 7 with a G7 ( 3+4 ).
Just got the most recent PSA back and I am very concerned.
Have an appt. with RO first week in Jan. 2019
Looking for some help on how to think about this "setback" and putting things in perspective.


12/07/2018
2.43 ng/mL

06/15/2018
1.63 ng/mL

03/16/2018
1.66 ng/mL

12/08/2017
2.44 ng/mL

06/02/2017
2.13 ng/mL

Post Edited (Bosco) : 12/9/2018 8:09:05 AM (GMT-7)

Posted 12/9/2018 3:24 PM (GMT 0)
Bosco, what you are experiencing is almost certainly the "PSA Bounce" that many patients get post-radiation. It is likely not something about which to be concerned. I suspect your RO will tell you the same thing. If you are particularly worried about this then CALL your RO's office and get their reaction now....no need to wait until January.

Jim
Posted 12/9/2018 3:48 PM (GMT 0)
Is a bounce typically that much ?
I assumed a bounce was a few tenths like I had earlier.
Is it typical to have more than one bounce ?
Posted 12/9/2018 4:42 PM (GMT 0)
I think you're fine. Many of us have bounces like yours. A bounce can be anywhere from a few tenths to a few whole numbers. Look at mine. You're right in that sweet spot for bounces—18 months after treatment, and can continue for several years.
Posted 12/9/2018 4:50 PM (GMT 0)
bouncy. You're in that time range.

You don't really have anything to worry about until you see a consistently rising pattern over a number of tests.

Just keep monitoring.

Andrew
Posted 12/9/2018 10:16 PM (GMT 0)
There is literature to suggest that patients that have "bounces" are more likely to have better outcomes overall. I bounced for years and finally settled down. It has taken 6 years to reach nadir.

Paul
Posted 12/10/2018 1:51 AM (GMT 0)
one or even two tests increasing is not to worry. RT is a much more long term ride than is RP.
Be well.

Roger
Posted 12/10/2018 2:20 AM (GMT 0)
I join the chorus and want to emphasize that you had a very similar PSA test result a year ago. But it would have been nice to see the downward trend continue. Let's hope for a lower result six months from now.
Posted 12/10/2018 6:54 AM (GMT 0)
Bosco..... Look at my signature if you want to see a bounce. But like all have said, it's part of the drill with SBRT. Unless and until you get several increases and establish a definitive upward trend that is consistent, then likely you are simply experiencing typical bounce that is to be expected. Either way, there isn't a thing that you can do about it and worrying doesn't help so forget about it and get on with your life. Right now, you look good.
Posted 12/10/2018 9:33 AM (GMT 0)
Thank you all for sharing your thoughts and allaying my fears. I am sure my RO at MSKCC will have similar thoughts when I see him after the New Year.
I have also noticed that my T-level has been dropping. about a year ago I was at 345, then dropped to 262 and now I’m at 218.
Any thoughts on that?
Posted 12/10/2018 2:55 PM (GMT 0)

Bosco said...
Thank you all for sharing your thoughts and allaying my fears. I am sure my RO at MSKCC will have similar thoughts when I see him after the New Year.
I have also noticed that my T-level has been dropping. about a year ago I was at 345, then dropped to 262 and now I’m at 218.
Any thoughts on that?

Not sure about your T level and that certainly may be completely independent of SBRT and PC in your situation. Again, my signature shows relative consistency with T level through all this. And your age may be a part of that issue. I'm 71 so it wouldn't surprise me to have a T level decline but I sure hope to avoid that as long as possible. That's an issue for your doc. There are SBRT guys here who are boosting their T level under their Drs supervision. Paxton comes to mind. Try reading his threads.
Posted 12/10/2018 4:25 PM (GMT 0)
I rarely see ploidy (genetic mutation of tumor) mentioned anywhere, anecdotal results, pathology, research, but is ploidy as good or better predictor of these variables? Diploid HAS to be better than aneuploid and both are found in high G cases. Perhaps ploidy is a proxy for G score.
Posted 12/16/2018 8:42 PM (GMT 0)
tarhoosier - You've lost me with this info. Way above my pay grade. The OP was a G3+4=7 at diagnosis, which is hardly a "high G" case.

I think he is just having a bouncy ride on the way to nadir. TA was/is a good example of this, as his case took about 6 years to nadir.

In my own case, I am now just over 2 years post-SBRT. My PSA started at 5.69 pre-treatment. It went down, then up, then level. . . until the 2-year point, at which it reached a new nadir of 1.9. That's the lowest it has been in 6 or 7 years. My RO and I are both comfortable with this, and will just watch it until we get bored with it. Unless it shows a clear upward trend of some significance, there is just no reason to become at all alarmed. Nothing to do but practice patience. . .
Posted 1/7/2019 3:00 PM (GMT 0)
Update :

Retested my PSA 30 days after my alleged "bounce" to 2.43 and it is back down to 1.63 which is what I had in June of 2018.
Feel much better about this and will be seeing Dr Z today to discuss.
BTW....T level is 241.
Thanks for all the support !

01/04/2019
1.63

12/07/2018
2.43

06/15/2018
1.63

03/16/2018
1.66

12/08/2017
2.44

06/02/2017
2.13
Posted 1/7/2019 3:03 PM (GMT 0)
Bouncy, bounce. Good number!!!

Down is good,
Andrew
Posted 1/7/2019 4:50 PM (GMT 0)
Aahhh. . . life in "The Bounce House." I'm glad you were able to get some statistical peace of mind.

If your T level concerns you (any symptoms?), there is growing support for the use of TRT (external T) for low to intermediate risk PCa patients. Google "Saturation Theory" + "Morgentaler" to read some of the research and publications that Dr. Morgentaler has authored or co-authored. He was instrumental in getting my Uro and RO to agree that I can continue my TRT before, during and after RT for PCa. Without it, I would definitely NOT be a happy camper, as I was badly symptomatic before I started TRT.
Posted 1/7/2019 6:33 PM (GMT 0)
Bocso, I'm glad things are back on track!

Jim
Posted 1/7/2019 6:47 PM (GMT 0)
Thanks Jim !

Paxton - I don’t think I have any symptoms attributable to low T but I’m curious what symptoms you had that I might look out for ?
Posted 1/8/2019 4:18 PM (GMT 0)

Bosco said...

Paxton - I don’t think I have any symptoms attributable to low T but I’m curious what symptoms you had that I might look out for ?

Well, let's see:
1. Depression (like seeing your life in black and white, while everyone else sees Technicolor)
2. Foggy brain - made lots of mistakes, which was unusual in my professional history; forgetful but too young for that
3. Loss of muscle mass
4. Loss of exercise tolerance
5. No libido
6. Weight gain
7. Strange emotional swings; moodiness; grumpiness
8. Didn't like life at all

If this sounds like not so bad a list, try having all of them at once. . .
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