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HOW DOES PSA DECLINE WITH TIME AFTER RT

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Posted 5/26/2013 11:03 PM (GMT 0)

My PCA was diagnosed 9/5/12 at age 78:

PSA 6.2 before biopsy, and 3.1 two months after IMRT/IGRT with 44 sesssions for a total Gy of 79.2. RT started on Dec 17, 2012 and ended Feb 19, 2013.

T1c (based on negative DRE and on tumor found during needle biopsy; but cancer on both sides)

Tumor length 3.5 mm

Biopsy results:

Core at left lateral mid: Gleason 4+3 involving less than 5% of the length of one core (0.3 mm tumor focus); percentage of Gleason score 4 =70%

Core at right apex: Gleason 3+3 involving less than 5% of the length of one core (0.5 mm tumor focus)

Core at right lateral mid: Gleason 3+4 involving 25% of the length of one core (2 mm tumor focus); percentage of Gleason score 4 =10%.

CT scan and bone scans negative.

Side effects-Increased urinary frequency and reduced flow rate. Flomax used for about two months which normalized urinary problems but created problems with stuffy nose causing sleep disturbance. Have stopped taking flowmax a month ago but do have some urinary problems.

My post RT PSA dropped to 3.1 in two months from the pre RT PSA of 6.2. My radiation oncologist seemed very happy with this 50% reduction, and asked me to come back in 6 months for a re-check. However, my personal care physician told me during my physical exam last week that PSA was still high.

How should PSA go down with time? What is a typical nadir value?

Thanks.

Posted 5/26/2013 11:44 PM (GMT 0)
Welcome to our corner of the world. Sorry you need to talking to us.

Sounds like you're doing just fine. Listen to your RO and not your personal doctor when it comes to the PSA. A 50% drop is great. It can take 1 to 2 years to hit nadir.

Also don't be surprised if the PSA bounces around a bit before it settles into nadir. "radiation bounce" is not uncommon.

Hang in there and keep us updated on your progress.

All the best,
Andrew
Posted 5/27/2013 12:05 AM (GMT 0)
Andrew is correct. That is a great decrease for 2 months!!
paul
Posted 5/27/2013 12:34 AM (GMT 0)
Think it is a great drop as well. If I am not mistaken this is the sort of drop doctors are looking for - 50%.
Posted 5/27/2013 12:38 AM (GMT 0)
The slower the drop the better the prognosis. A nadir of .5 or lower is considered optimal. Best situation is to reach the nadir about 24 months after last treatment. Be aware that you can get a bump where the PSA rises briefly and then begins to go down again.

It does not appear that you are on HT so your PSA should be a reliable indicator.

Best of luck to you.

Don

Posted 5/27/2013 1:12 AM (GMT 0)
Thanks, everybody. I will keep posting.
Posted 5/27/2013 1:37 AM (GMT 0)
Dear Attich:

Welcome to HW but sorry you have to be here.  It sounds to me that your PSA progress is just fine and I suggest you listen to your RO on this as he should be the expert.  I had brachy (seeds) and was told to hope for a 50% reduction after 6 months.

Reaching a nadir depends on lots of things that are patient specific...it could take several years. 

Good luck and please keep us posted.

Jim

Posted 5/27/2013 3:31 AM (GMT 0)
Welcome to HW PC

You are doing well for a RT guy, good decline so far.

And as others have said, don't be surprised for a bounce at some point, normal for one having RT as a primary treatment.

Look forward to future posts from you, good luck ahead

david in sc
Posted 5/27/2013 10:05 AM (GMT 0)
If you have a bounce (quick upward psa) the good news is it is followed by a nice downward drop not to long afterwards, happens in maybe 30% or so of radiation type patients. How radiation works, is that it is a slow kill (not immediate zap like in the cartoons-lol), it alters the fast growing cells (Cancer cells) DNA chain and eventually they cannot reproduce (as I comprehend this stuff).
Posted 5/27/2013 5:29 PM (GMT 0)
ATTICH,
Radiation doesn't kill PC cells. It affects their DNA and keeps them from dividing. Cancer is cells that divide much more rapidly than normal cells. So with radiation the cells only die when they divide. Depending on the dividing time of your individual cancer cells, psa doubling time, faster growing cancers die more quickly.
The nadir you are looking for is below 1 and it could take a few years to reach that nadir. For example, if your psa doubling time is 3 years you can expect all of the cancer cells to die within that time. Since you still have a prostate you will always have some PSA, unlike surgery patients. A reoccurrence is defined as three consecutive rises in PSA. Any nadir that reaches .2 has a very low probability of ever reoccurring.
Posted 5/28/2013 3:47 AM (GMT 0)
Attich - It sounds you are doing great! Best of luck.

John T said...
A reoccurrence is defined as three consecutive rises in PSA.

That is the definition I guess, but nothing is that simple it seems! I had IMRT as my only treatment six years ago and after 12 months my PSA dropped to 0.32. Good, right? Over the next 18 months it rose steadily to 1.08 (three consecutive rises). Not good, right? We ( uro and I) decided to not act. Now 4.5 years later the PSA is 0.48 and in that time it has bounced around a bit between 0.4ish and 0.6ish. Who knows.....

However, I am glad didn't take any action when I had an "official" reoccurrence.
Posted 10/28/2014 7:19 PM (GMT 0)
After i year 8 months, my PSA has declined to 0.6. It was 6.2 before RT.
I now see pinkish blood in my semen. Any advice? My first post is pasted below:

My PCA was diagnosed 9/5/12 at age 78:
PSA 6.2 before biopsy, and 3.1 two months after IMRT/IGRT with 44 sesssions for a total Gy of 79.2. RT started on Dec 17, 2012 and ended Feb 19, 2013.
T1c (based on negative DRE and on tumor found during needle biopsy; but cancer on both sides)
Tumor length 3.5 mm
Biopsy results:
Core at left lateral mid: Gleason 4+3 involving less than 5% of the length of one core (0.3 mm tumor focus); percentage of Gleason score 4 =70%
Core at right apex: Gleason 3+3 involving less than 5% of the length of one core (0.5 mm tumor focus)
Core at right lateral mid: Gleason 3+4 involving 25% of the length of one core (2 mm tumor focus); percentage of Gleason score 4 =10%.
CT scan and bone scans negative.
Side effects-Increased urinary frequency and reduced flow rate. Flomax used for about two months which normalized urinary problems but created problems with stuffy nose causing sleep disturbance. Have stopped taking flowmax a month ago but do have some urinary problems.
My post RT PSA dropped to 3.1 in two months from the pre RT PSA of 6.2. My radiation oncologist seemed very happy with this 50% reduction, and asked me to come back in 6 months for a re-check. However, my personal care physician told me during my physical exam last week that PSA was still high.
How should PSA go down with time? What is a typical na
Posted 10/28/2014 7:23 PM (GMT 0)
call you URO. Likely nothing but any bleeding should get checked out.

Andrew
Posted 10/28/2014 7:30 PM (GMT 0)
I still get some drops of blood from time to time when I "ejaculate." My RO tells me it's probably from scar tissue breaking loose. Congratulations on your low PSA.

- Allen
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