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SBRT -5yrs out

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Posted 4/19/2021 7:12 PM (GMT 0)
Hello All , I have had about 21 PSA draws since my baseline of 6.87 on 02-04-16 . My latest was 4-12-21 at 1.4 . If you see my signature my Nadir should be around .83 which was taken on 9-18-18 . So I understand the bounces . I have my yearly in person with my Uro this week . Any of Ya all out there can think of any questions I might ask him ? Is the beast out of the barn ? My rad onc once asked me if I had hemmoroids ? I said no but I discovered some . So can hemmoroids cause psa to rise ? Besides that Im doing well , hope you all are too . SemperFi , John
Posted 4/19/2021 9:45 PM (GMT 0)
Nope
Posted 4/19/2021 11:12 PM (GMT 0)
Your results are pretty normal for an SBRT patient. Enjoy!
With respect to questions, you can ask whether your internet 'doctor' interpreted the data correctly.

Post Edited (Sr Sailor) : 4/19/2021 5:16:12 PM (GMT-6)

Posted 4/20/2021 1:35 PM (GMT 0)
Sr Sailor I'm curious if you could expand on your comment "Your results are pretty normal for an SBRT patient." I am looking into SBRT as a treatment option for my prostate cancer but haven't made a final decision.
Posted 4/20/2021 5:52 PM (GMT 0)
Kevin,

I can't speak to exactly what he meant, but....

When you use radiation as your primary treatment, whether it is external beam, brachy, SBRT, or some combo, your PSA will drop to a low level over a period of time--a year or so is not uncommon--and that point is called your nadir. After that, bounces are not uncommon, but eventually it settles to a stable low point. If it starts a steady rise after that point, then the concern can start.
Posted 4/21/2021 3:18 AM (GMT 0)
Halbert, thank you for the feedback.
Posted 4/21/2021 7:18 PM (GMT 0)
Halbert answered your question pretty much like I would have.
I will repeat that those who have received radiation therapy should continue to get PSA tests at regular intervals. Initially more frequently (often quarterly), but if there is no cause for alarm, on a semi- or yearly basis. The PSA nadir may occur sooner or later (after one or more years).
The current recommendation is that action is required once the PSA reaches nadir + 2 ng/ml (the Phoenix criterion for biochemical failure).
Posted 4/22/2021 2:46 PM (GMT 0)
John, the trend line looks fairly steady. It is very usual for radiation men to express PSA since the prostate is intact. You are also still vulnerable to inflammations that can express more PSA,

You made a good point about the nadir and bounce that looks like it happened in the 2-3 year range after treatment. Now the concern appears to be whether the more recent readings are of concern since you had a bump to 1.6, but then the last two are lower. As long as you stay within a specific range and don’t experience a constant upward trend that takes you above that 2.83 threshold, I would be pleased.

The RO question regarding hemorrhoids is common as some men develop them from the radiation. But they have nothing to do with PSA. When I was still visiting my RO for follow up exams I always completed a very detailed questionnaire regarding urinary, bowel and sexual functions. The question about hemorrhoids was also asked. These are the areas some men have treatment side effects and need to be monitored for possible treatments.

Sounds like you are doing fine and hopefully your urologist visit goes well.
Posted 4/23/2021 12:15 AM (GMT 0)
John,

From one Post Toastie to another, I think you're doing fine. I am a few months behind you, having finished my SBRT in November of 2016. My 4 1/2 year PSA was the same as the prior one -- 0.96, from a pre-treatment high of 5.69. I've also had bounces along the way, but as JNF noted, as long as there is not a steady upward trend taking you past nadir + 2, I would just hang on and enjoy the ride.

Some of us do take a long time to reach nadir, but as long as that upward trend doesn't happen, all we can do is watch the show.

Yes, it can be unnerving. But all the research says to stay the course.

Congratulations to you!
Posted 4/23/2021 5:36 PM (GMT 0)
Hey Paxton good to hear from you , as well as you all . i saw my Uro yesterday and he said not to worry, and I wasnt really worried because we knew the game going in .. In 6 months he will give me their sensitive PSA draw in their office . I also go to VA for my annual lab work . The VA 4 out of 5 years have been higher except 1 , such as 4.74 , 2.39 , 1.23 , 1.01 and 2.04 on 2/08/21 and my last from the hospital was 1.4 All the others on my signature were from the Silver Cross hospital . So my Uro said he will stick with the hospital scores . makes me wonder . Thanks All , SemperFi , John
Posted 4/23/2021 7:25 PM (GMT 0)
Hi John, Another Post Toastie here. I have had no issues with hemorrhoids and possibly your’s may not be related to the SBRT. I’ve not heard of hemorrhoids being related to PSA. For myself some mild urinary symptoms resolved on their own about two weeks following treatment. I believe my urinary function may actually been better since treatment. I rarely get up at night unless I’ve had too much coffee. My post treatment side effects have been unremarkable. My PSA has been a little bouncy and the folks at Cleveland Clinic have said it’s typical for SBRT and not to worry. I get a PSA every six months at Quest Diagnostics. I did find a bias between Quest and our local hospital and only include Quest numbers in my signature. Terry
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