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Posted 10/14/2019 3:49 PM (GMT 0)
Post TX in late 2017, my PSA values started going down but in August of last year it went up to 1.8ng/mL. In November of same year, it went down to 1.3ng/mL. Then in August this year it went back up to 1.8ng/mL and now it has gone up to 2.3ng/mL. My Urologist is concerned and requested MRI (3T) of the prostate prior to biopsy. I am seeing my Doctor in a week. I am worried and would appreciate any opinions and similar experiences.
Post HDR BT PSA update: 12/17-(2.0), 3/18-(1.7), 5/18-(1.4), 8/18-(1.8), 11/18-(1.3), 8/19-(1.8), 10/19-(2.3).
Posted 10/14/2019 4:00 PM (GMT 0)
I understand the worry, but it could just be normal bouncing. MRI may not tell you anything. PSA testing over time will tell the tale. It’s hard, but try to be patient.

Good luck!
Posted 10/14/2019 4:08 PM (GMT 0)
PSA post RT can be bouncy. Reoccurrence post RT is nadir + 2. In your case that looks like 3.3 so you're still below that.

Good to talk to a doc about it.

Likely you'll get the "wait and see" answer. It's possible that the result is a lab error, so you'll want to retest in a few months to confirm. But some scans might be in order at this point.

Andrew
Posted 10/14/2019 4:13 PM (GMT 0)
Normally it takes a few to several years to reach the true PSA nadir following radiation as a primary initial treatment. During that time it is also normal to see some bouncing around in the 18-36 month range, which for you is now. Ideally, after radiation you want to get your PSA under 0.50. It is not too late for that to occur, it just hasn't. Your nadir thus far is 1.3 and technical recurrence is determined at nadir plus 2.0. Right now for you that would be PSA of 3.3. While you are G6, you had a good amount of involvement. Most often the G6 wont cause problems, but you should never trust it. Also you still have your prostate that is expected to express some PSA as well as any possibility of prostatitis or even treatment iritation, which you could have.

All you can do is what you are doing. Be concerned, but not worried, and attempt to determine whether this is a new normal without cancer, or if there is something nefarious at work that needs some clean up.
Posted 10/14/2019 11:02 PM (GMT 0)
An MRI with a 3Tesla instrument and contrast fluid would be informative.
Posted 10/22/2019 11:17 PM (GMT 0)
MRI clear and my Uro adviced to wait and see while PSA test to be done in a few weeks time. Thanks alot for all your contributions.
Lanky
Posted 12/8/2019 3:14 AM (GMT 0)
Result for PSA test done last week is 2.1ng/mL. My Uro suspects a biochemical failure has occurred. He recommends a biopsy. Any ideas will be appreciated.
Thanks for your usual support and ideas.
Posted 12/8/2019 5:00 AM (GMT 0)
You have good insurance and your uro wants more ...he got it with the MRI...You need a radiation oncologist...which is where you should have gone to as soon as you had the concern...your concern btw was unwarranted......you will not like this revelation...but the folks that have already responded ...know that what I just said is spot on...but everyone wants to be a "nice "guy and not make you feel bad..Yep I see way to much...and when I present that truth...they see it as well...but again nice...interesting that the forum is made mostly of men...yet they fulfil a feminine aspect to the interaction they have with newbies...and quite frankly hurt them with that "comfort" by feminine I mean...Isn't it usually the mother that spoils little jonny...while the dad ..if he has any moxee ...make him toe the line...I realize their is a mix today in the present paradigm...but still the dynamic is there...in a nutshell...you do not help little jonny...you hurt him...why can y'all not see that...never mind...you just can't No fault...which does not ...sadly alter the natural effect of that... a price will be paid...now that you know that...and you do...glory to glory you do...but you just can't help yourself...ive seen this lack on two threads..just today.and The Band Played On..no worries long term...we will evolve...we will get thru this last gasp of dinosours...It could be decades or even centuries...mankind always does and always will...but woe to those in the in between and that in between may be a lot longer than one can imagine.if anyone imagines at all...im my view a man in the highest sense of that meaning and a women...in the highest meaning of that word...should consider the words of old "whats his name": "if not me who...if not now when"...as is my way...apparently...on this forum...I will leave for awhile...and return in my own good time...trust me...you will know if I pass...for reasons I will not reveal...and no shame on anyone...do not troll me back(as I do pop in tho rarely )...and yes..do I think I have wisdom...you bet your bippy I do...Lo...Lo...turn unto wisdom and it is there...wow that felt like peace...the peace...of the stillness of time...melting this ole soul of mine...maranatha


big PS...I assure you I am as healthy as an ox...and plan on living well into my nineties with a window open groaning in the end to stay open...then a bit o this...a bit o that...and the window...bam...slams...with the same peace of the now that I wrote of above...ain't it grand...ain't it dagnab grand....
Posted 12/8/2019 7:10 AM (GMT 0)
Your PSA reduced since the last read. Why the hurry to biopsy a radiated prostate? If it goes down again in another three months it will be indicative of the classic radiation bounce. What does the radiation oncologist say? With a clear MRI and G6 your doc should also be considering other causes like prostatitis, which is not unusual as you still have your prostate. Did you get an assessment of your biopsy slides from Epstein? Maybe your G6 actually had some higher grade PCa. Shouldn’t be too late to get another opinion before another biopsy.
Posted 12/8/2019 6:04 PM (GMT 0)
You might want to read “Another Reason to Love Your Bounces” on the New prostate Cancer Info Link. If you look at my signature you’ll see I’m also in the bounce time period. My RO is not concerned and reminds me that RT for PC is a marathon and not a sprint. I’m no longer under the care of a urologist and take my advice from my RO who specializes in PC. How are your side effects and are you happy with your treatment? Although I had SBRT my understanding is that it was patterned after the excellent results from HDBT.
Posted 12/8/2019 9:06 PM (GMT 0)
Thank you for your timely responses. To JNF question, I have not discussed this recent development with the RO and did not seek second assessment from Epstein. I will schedule to see the RO and try to have Epstein assess my biopsy slides ASAP. Side effects? I am on Tamsulosin 5mg daily. I wake up to pee at least two times every night.
Posted 12/9/2019 12:39 AM (GMT 0)
The rule of nadir + 2 for recurrence after radiation treatment is a general formula used by many. In my case, I reached a nadir of 0.1 after brachytherapy for Gleason 3 + 3 cancer. Five years after my treatment, a large extra-capsular recurrence was confirmed by biopsy when my PSA reached 1.5 (well below the nadir + 2 ). A PET/CT scan would be more appropriate for recurrence. In 2018, when my treatment for the recurrent cancer failed indicated by rapidly rising PSA a bone scan and 3T MRI were clean, but a PET/CT at NIH found metastatic cancer in many lymph nodes. The metastatic cancer was confirmed by biopsy of one of the lymph nodes.
Posted 3/15/2020 5:32 PM (GMT 0)
I like to share this PSA test recent update. The result came in yesterday and my RO said it went up from 2.3ng/mL in October 2019 to 3.2ng/mL last week. He is concerned as much as I am. I will be seeing him this week.
Posted 3/15/2020 5:38 PM (GMT 0)
boinces are normal 0n the road to cure after radiation. Looks like you’ve had a few. . With that said it looks like your PSA has been trending up since November 2018, so there’s that. I don’t know. Others will chime in as to the typical characteristics of a bounce over time.
I’d be curious w
Posted 3/15/2020 6:30 PM (GMT 0)
Run the scans. As I understand, you did not have external beam radiation or ADT, correct? You may want to add 25 fractions of EBRT and catch the pelvic lymph nodes. If you are really worried 6-9 months of ADT can be added. All would be much more aggressive than just the mono-therapy HDRBT. If it is recurrence it means you had PCa outside the original radiation area. Now you have to find it and mop it up best you can. You had a lot of positive cores and a fairly large prostate. Possible you are going to express more PSA due to size. Also possible there was some G4 that the biopsy did not pick up and had already been outside the initial radiation area.

The good news is that you have a lot of salvage options. Actually Much better than when surgeries fail and are limited to SRT. You can generally have EBRT, SBRT, more HDR-BT, cryo, HIFU and Nanoknife. next step looks to be finding the source of the PSA rise.
Posted 3/15/2020 8:00 PM (GMT 0)
Lanky,
RT guys usually have far fewer of the nasty side effects that surgery guys experience. Both treatments have approximately equal cure rates. That said...we still have our ‘toasted’ prostates and our PSA doesn’t immediately drop to nothing like the RP guys. I see pluses and minuses to either treatment choice. PSA bounces occur in 25-35% of RT guys and it happens between 20 and 48 months following treatment.

I understand and share your concern; however, you still have your prostate and the bounces may have other causes than recurrence. Some that I can think of include more than one lab doing the testing, the size of your prostate, possible sexual activity too close to testing, infection, cycling, etc. For comparison purposes my post SBRT PSA’s are in my signature. My bounce was at 14-28 months and my last PSA at 32 months. I found my RO to be much more knowledgeable than either my Urologist or PCP regarding post treatment PSA. Good luck and keep us posted.
Posted 3/16/2020 12:19 AM (GMT 0)
Lanky, I'm in the same situation right now.

Although your treatment was a few months ahead of mine (EBRT followed by Brachytherapy on Feb 1 2018) I'm getting another PSA test tomorrow. My previous PSA test 3 months ago was 3.2: the one six months earlier was half that at 1.6. I’ve discovered that bounces can do that more so than a recurrence.

I freaked out and in a panic called my RO. It was Friday December the 13th. Surprisingly, he was at his desk and answered the phone. He too was concerned (that later freaked me out even more) and ordered another PSA test in 3 months and a PET scan. The PET scan hasn’t happened yet,

Over the last 3 months I’ve searched the internet like a madman for insight on having a PSA 2.3 above my nadir. Apparently, about 50% of bounces over 2 can still prove to be ‘just a big bounce’ and you eventually fall back down to below your nadir. Also, I’m not a big man (120lbs and a BMI of about 21.5) and I’ve obsessed on the fact that for me my PSA is more on the concentrated side as apposed to very big men where it is documented that the PSA is diluted (hemodilution).

Most importantly, I’ve learnt that it is only after 3 full years that you can conclude failure or success with your treatment.

Search for 'Vision 10' in this forum and you’ll see a "wild ride" that ended with his PSA very low but only about 3 years after his treatment.
Posted 3/24/2020 4:44 PM (GMT 0)
My RO visit update; he reviewed the 3T MRI result and said it was clear. He does not think a biochemical failure has occurred as the URO thinks. He said he is confident that the PSA will eventually drop but not sure when. However, he recommends I do two more PSA tests 3 months apart before having a biopsy. The next PSA test comes up in June while my anxiety continues! I am coming up on 3years post HDBT and don't know what options I have at this point.
Posted 3/24/2020 5:11 PM (GMT 0)
Retesting is prudent and an anxiety generator.

Hopefully you won't have to figure out your options are.
Posted 3/24/2020 5:28 PM (GMT 0)
" However, he recommends I do two more PSA tests 3 months apart before having a biopsy."

Having a biopsy? I'm not sure what you mean by that. Are you referring to your earlier post about Epstein reviewing your slides? If so, it's not clear to me that would provide any advantage at this point.

In any case, let's be hopeful you PSA heads down. Good luck!
Posted 3/24/2020 10:57 PM (GMT 0)
No, it's not the biopsy at diagnosis. My URO earlier suggested a second biopsy when I expressed concern about the upward trend of my PSA. So, I sought the RO's opinion.
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