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Disappointing Test Results

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Posted 10/9/2013 2:06 PM (GMT 0)
Harold had HDR brachytherapy in February.  His 3 month PSA test result was 1.3.  His current 6 month PSA reading that he got yesterday was 2.9.  I am panicked.  He has a call into his doc and has emailed him as well. Your thoughts, please.
Posted 10/9/2013 2:19 PM (GMT 0)
Hello.
Some experts use a criteria of nadir +2. The lowest PSA plus 2 as recurrence. Doctors disagree on the criteria. I hope it was just a glitch. Good luck.
Posted 10/9/2013 2:22 PM (GMT 0)
Understand the disappointment, but it may head up slightly before it starts to go down. Hopefully that is the case, and by his next reading, you will see some improvement.

david
Posted 10/9/2013 2:30 PM (GMT 0)
I had radiation (SBRT not BT) and one of the things I was warned about was the "bounce effect" that radiation can have in connection with PSA results. I was told there are times the PSA will "bounce" to a higher reading and that it's not at all uncommon, and not always cause for concern. Are they schedualed to do another PSA in 3 months? They may wait until that one to see if it starts going down again, before being concerned.
Posted 10/9/2013 4:29 PM (GMT 0)
Hello Viv and sorry for your and Harold's concerns. With LDR brachy I did not have my first PSA test for 6 months and was told that if the PSA number was down by 50% I should be happy. By that standard, Harold is still doing well.

I am not terribly familiar with the bounce issues with HDR brachy but with LDR this would be a little soon for a bounce effect but some of the HDR boys may chime in on this.

Only three successive increases from the nadir would typically indicate BCR and a needed salvage treatment. Obviously your doc will have something to say about this.

I hope for the best for you and Harold and please let us know how the doc responds.

Jm
Posted 10/9/2013 5:24 PM (GMT 0)
I vote for a retest. Sorry you have to be dealing with this again. Could be a bounce but like others have said, you need to see a couple of rising numbers before you need to think about getting more treatments.

Andrew
Posted 10/9/2013 6:20 PM (GMT 0)
I'm sorry that both of you are going through this again. I vote for a retest also since " a bounce" usually occurs around 18 months to 2 years and is normally not more than .5...I still consider myself an uninformed newbee and love to deliver good news so I apologize.
Wait 3 months and have another psa test and rely on your oncologist or whoever you have faith in; if necessary, radiation and hormones are options if you desire to go that route. REMEMBER, it may never progress!
Bill idea
Posted 10/9/2013 6:45 PM (GMT 0)
Hi Viv - I wanted to try and help with this, so I did some quick research.  With respect to the topic of PSA Bounce with HDR - I found the following from a report by Dr. Jeffrey DeManes of the CET/UCLA (Can't remember if DeManes did Harold's treatment or another staff member, but in any case this will hopefully be relevant and helpful?)

"If a rise is detected, more frequent testing is carried out. We caution patients must that a rise in PSA after HDR with or without EBRT does not necessarily mean that the cancer has recurred. Transient rises called PSA bounce can be seen months to years after treatment and should not be misinterpreted as treatment failures."

I added the bold/underline because I think it relates to where you guys are at now, some 7+ months post treatment.

Hang in there, contact the folks at UCLA and get their input on this!

Best to you both.

Posted 10/9/2013 8:51 PM (GMT 0)
thank you all for your helpful responses. hopefully we will hear from dr demanes soon.
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