Radiation Bounce

I haven't posted in a couple months but brief history is SBRT/CyberKnife Oct '20 when PSA was ~ 9.0. After the treatments:

1/25/21 PSA: 0.84
8/5/21 PSA: 0.68
2/9/22 PSA: 1.10
3/22/22 PSA: 1.46
6/13/22 PSA: 1.09

At the 3/22 reading it appeared that the cancer was back and my docs wanted me to proceed with treatment (salvage RP, cryotherapy, HDR). After consulting with several specialists around the country, Dr. Martinez at Detroit (HDR) said I was moving too quick and it was likely a radiation bounce. The 6/22 reading gave me hope that he may be right and both of my local docs then agreed to wait...

Yesterday's PSA reading was 0.66, just under the previous nadir, so it appears that's what it was.

Now I can exhale

Both Dr. Martinez and another doc at SK NY said the same thing, that I was being nudged into treatment too soon and that I should wait. I also recall one of the members here (can't remember his name right now) who had the same situation and was consoled by his team to wait when his PSA had risen I believe into the 2's and it also dropped.

PS Ignore the last line in my signature; the date should be 10/3/22 not 8/3/22

Vic, smart thinking on your part! This is one of the tough parts of PCa, i.e. the need to be our own advocates, be educated and make sound decisions for ourselves. Clearly you are doing that.

Jim

Great news!

Hey Terry, it was you who I was thinking about. your signature was one of the things that convinced me to ask questions when mine started climbing. Hopefully mine will stay under 1.0 for many years

So the Captain Obvious statement I think is good for RT patients to know, as I didn't know it and came across it almost by accident, but just in time: "Radiation bounce is a real thing and can occur several years after treatment" (mine was 18 mo.). There's a so-called Phoenix protocol that states something like you should not be too concerned until your PSA is nadir (lowest PSA reading to date) + 2. My nadir had been 0.65, so I should have started to be concerned maybe at 2.65, yet my UO was talking about cryo or salvage RP at 1.46!

My RO yesterday said it was cells that had not yet died but were on their way. I'm a bit curious as to the mechanism but it appears to be complicated, more than just the last gasps of dying cells. I pulled up one article and said (among other things):

"Using mathematical modeling on the timing of the bounce, they postulated that radiotherapy initially kills radiosensitive infiltrating T cells, but, after a delay (corresponding to a decay in source activity for low-dose-rate brachytherapy), these cells return and launch an anti-tumor response that ultimate causes the bounce. They further postulated that anti-tumor immune action by these infiltrating lymphocytes is limited by the prostate primary tumor, and radiation-mediated tumor kill helps “unleash” these lymphocytes."

I'm not a biology major but if anybody as a better understanding of what this mechanism is, please chime in.

Vic,
What a bizarre story. I was trying to decide which docs may have advised you towards further treatment. Then it occurred to me that it doesn't matter. Any PCa practitioner -- Urologist, RO, or MO -- should not have made such an error in judgement.

A salvage RP sounds particularly nasty. I don't recall any forum members having this procedure. It's hard for me to imagine that it would even work.

Anyway, I'm glad it all worked out.

When I had radiation treatments (45 treatments given over 9 weeks), my doctors said I should prepare to ride the "roller coaster" for a time ~ as PSA values can fluctuate.

I think that's a good visual description ~ "riding the roller coaster!"

Your treatments, like mine, are paying dividends!

Things to be thankful for ~ today!

CYCLONE ~ # Iowa State University