Post HDR Brachytherapy PSA Level

this past december, i turned 47. in feb. 2019, i was diagnosed with GS 4+3=7 PCa. in july of that year, i was treated with 6 months of casodex 50mg. until january of 2020. january 9th and 23rd, i received HDR brachytherapy. at diagnosis, my PSA was 11.9, later that year, after going a few weeks without casodex, my PSA went up to 12.68, then in december of 2019, my PSA went down 11.45. i was sched. to have my first PSA 6 months after my HDR treatments, but because of COVID-19, my RO says i can afford to wait another 6 months to have a PSA. so two days ago, i had my first PSA and the results came back, 4.04.

this has my RO concerned because he feels that my PSA should've gone down much further. i'm a bit confused because i thought as long as the PSA was going down, that's a good thing. so, i'd like to know what are your thoughts? i'm scared, man!

1st. i want to thank you for responding so quickly. i'm being treated in atlanta, ga. at emory winship cancer institute. for quite a while during the pandamic, emory stopped accepting patients and canceled a lot of procedures. my RO told me i could afford to wait another 6 months. my next PSA is scheduled in 6 weeks. i guess they feel since it's been a year and this is my first PSA they feel it should've dropped much further from 12.68 down to 4.04. my RO feels it should be closer to 2 or less. this is Y i'm scared, because i thought it was a good progress. i was born with a phys. disability and my bone structure is not that great. so that's why i only took casodex 50mg before having HDR.

Sammas, I am also in the Atlanta area. You have had a very significant drop in PSA in the year since treatment and that is what you want. I would rather see you on quarterly PSA tests and you can do so even with COVID. My urologist hasn’t missed any as I continue to be on a quarterly schedule. If you can’t get them at Emory let me know and I will connect you with my docs.

The key after radiation therapy is reduction in PSA. The absolute values are less important at any given time as long as there is a downward trend. Most men take 3-5 years to reach their nadir. Ideally your PSA nadir will get to 0.50.

Since you have an intact prostate you should expect to have PSA expression. What was your estimated prostate size? If you had enlargement from prostatitis or BPH it is possible you still have the condition in spite of the radiation. Have you had any scans? MRI?

I hope your RO has clearly explained what to expect. The Casodex would not quickly reduce your PSA significantly as it does not reduce your testosterone to starve the PCa. Rather, it is a blockade. Please be concerned, but not worried or scared. If your doctor isn’t meeting your needs, there are others that may be a better match for you. It is your life, not his, that matters in this situation. You need to be well served.

Definitely do what it takes to get quarterly PSA tests to monitor the trend. If your RO won’t do the test, then get your GP to do so, or message me and my uro will see you and get the test done. The trend is important and now is the time to clearly understand it.

JNF said...

What was your estimated prostate size?

my estimated prostate size = 38.6. in 2014, i had a trus biopsy and the findings for PCa were benign, but BPH and prostatitis were found.

JNF said...
Have you had any scans? MRI?

my most recent MRI was in 2018.
bone scan in march 2019

JNF said...
....Definitely do what it takes to get quarterly PSA tests to monitor the trend. If your RO won’t do the test, then get your GP to do so, or message me and my uro will see you and get the test done. The trend is important and now is the time to clearly understand it.

because of COVID-19 emory/winship cancer institute was not seeing any patients. but as of this year, they're allowing its patients to come in and have tests and procedures. so i'm scheduled to go back in about 6 weeks for my next PSA.

would it be all right if we could either exchange emails or phone numbers?

Post Edited (Sammas) : 1/23/2021 8:42:16 PM (GMT-7)

F8 said...

Sammas said...

F8 said...
...maybe i read your post wrong. sorry. your initial post is prettty convoluted. i read diagnosed in the beginning of 2019 and treated 11 month later, which was prior to covid 19.

U have my apologies. i'm so wired up i can barely think straight. i guess what has me so out of it is my RO doesn't think my PSA will drop any lower.

Sammas,

You owe no apologies. I get it. I empathize. In your boots, my feelings would be the same, sir. And, in fact, they were when I first got my diagnosis and immediately after treatment.

PCa, standing alone, is bad enough. Having the 'effing COVID curse pose obstacles to diagnosis and timely treatment only serve to compound and prove weighty on human emotion, It does not, in any manner, make one a weakling.

I "met" the Brothers on this website last spring. In my book, they are all stand-up guys. They will always be here for you, me and anyone who rings their bells. And they will not fail you.

Godspeed, my Brother.

NJ Fred

NJFred said...
Sammas,

You owe no apologies. I get it. I empathize. In your boots, my feelings would be the same, sir...

Thank you so much for understanding.

I cannot see why your RO thinks your PSA won't drop any lower. With only one post-treatment test, there's not enough information to establish a trend. In fact, even with multiple PSA tests it can be difficult to establish a trend--it's very common for PSA to bounce around after radiation--it's probably one of the more commonly things discussed here.

I'm glad that you're getting another PSA test in 6 weeks and I do hope you're on a regular testing schedule. And I'm glad you're connecting with JNF, who is a very knowledgeable guy and happens to be in your backyard to boot.

Just remember that radiation for PCa requires patience. It takes a while to kill off all the bad guys. HDR brachy is an effective treatment so try and keep the faith!

Turboz said...
If I understand correctly, prior to HDR your PSA was 12.68, and roughly 1 yr post treatment you are at PSA of 4 or about 75% decrease.

I was PSA of 9.6 and at 9 months was 2.7 or 82% decrease, this road takes time. It has taken me 2 yrs 9 mo to get below 1.

my guess is that since it's been a year, the doctors thought my PSA would've been at or below 2.

Turboz said...
...How are you doing on side effects, hopefully your doing well on that end.

Hang in there.

yes. all of my side effects seem to have subsided. i sleep well through the night, my urinary stream has come back to normal and i don't go as frequent. no pains, no flomax, no weight loss.

Post Edited (Sammas) : 1/25/2021 10:25:17 AM (GMT-7)