Could a PSA bounce occur more than 12 months after radiation?

Would help if you could put up your father's "signature" so we could remember his situation and treatments.

I thought your father had surgery first, then radiation. If so, there is typically no radiation bounce when radiation is used as a secondary treatment. I had salvage radiation, and mine failed after 9 months.

If your father only had radiation, as a primary treatment, there is typically a bounce at some point.

Perhaps you could refresh our memory.

Hope your father is feeling fine.

David in SC

Hi Lynn You are a “fighting girl” and I like to see you so involved in the care of your father’s case. I read some of your threads and know about the events your dad has been through, in particular the lesions caused by radiation. You have commented that your dad has a scheduled appointment to meet Dr. Myers. I am thinking that you mean a meeting with the famous oncologist Dr. Charles “Snuffy” Myers which is one of the leading experts in prostate cancer in the world . This is the best “shot” your father is doing to handle his case.   I would recommend you to prepare a long list of questions, even if they seem odd to you, and pass them on to Dr. Myers. He will surely give you answers to all those doubts you have exposed in this forum.   My opinion on the last three PSAs taken in June, August and September, indicate that something is still causing that little bit of antigens (0.07-0.17-0.15 ng/ml), now at the 15-months mark after the end of SRT. However, this is not indicative yet of a failed SRT. ASTRO norms indicate that recurrence is declared after three consecutive rises of PSA levels from nadir (the lowest registered) which were taken at least one month apart. The value of 0.07 can be taken as the nadir PSA if we consider that the influence of adjuvant HT is over at the time of drawing blood to that test (12 months latter). The small difference between the following two tests with a rise of 0.17 and 0.15, could be significative of a plateau but it could also be related to the assays tolerances or even to the day your father draw blood (biorhythms influence). I believe that we need two more rises to affirmatively declare recurrence.   In your dad’s case (SRT after RP) the so called “bounce PSA” should not be normal to occur. This is more for cases where the prostate is still in place (no surgery) and where prostatic benign cells are alive producing PSA. I would wait for at least one more PSA test before drawing any conclusion.   Dr. Myers has made a presentation recently regarding his findings on oligometastatic cancer. He believes that cancer firstly metastasizes to the lymph nodes and sets there in a transitional state between localized and systemic. You can inquire if such would be his opinion on your dad’s case but most probably the SRT protocol of your dad (72Gy in 40 sessions) in April-May 2010 may have included and radiated those difficult to access lymph nodes. I am not sure if your dad could get more radiation on the same spots.   Nevertheless, in the event of occurrence your dad has many ways to fight the cancer. Hormonal treatment is very effective in addressing such recurrences. I also experienced two failed treatments (RP and SRT) and am now on HT. My nadir PSA after radiation occur on the 13 th month at 0.05, it plateaued for a while, but then start rising. My doctor used a threshold of PSA=1 as a trigger to start the hormonal treatment, which occur 46 months from the end of radiation. My last PSA on a single protocol with Eligard decreased the value to 0.03.   Your dad will do well too.   Baptista

Thank you Baptista, for being so thorough with me. So is it standard to begin hormonal treatment at a PSA of 1?

PSA bounce is caused by the dying cells of normal prostate tissue releasing psa as in their last gasp. This may ocurr within 24 months of primary treatment with any type of radiation. It is usually indicated by an up and down reading of psa over a few months. A slow and steady rise over 3 consequetive reading indicates that cancer is still present and growing. since you dad has had his prostate removed there should be no bounce.