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PSA score after radiation

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Posted 10/8/2015 3:51 PM (GMT 0)
My husband had a Gleason score of 7, 3 years ago and had Robotic surgery to remove his prostate at Mayo Clinic in Rochester, Mn. No Cancer was found in the lymph nodes or any surrounding tissue. At the 3 year mark his PSA score started rising and he went through 7 weeks of Radiation. He just had his first PSA test at the 6 month mark. It has gone up from 0.35 to 0.45. The Dr said not to worry and wait longer. The report said it was steady or Declining? I am very confused. My husband is out of the country right now so he can't call the Dr. He is 64.
Posted 10/8/2015 4:30 PM (GMT 0)
Post RT, PSA can become bouncy. Frustrating, but just something to watch.

Think of it this way: The RT just killed millions of PC cells and all those cells released their PSA at once into the blood stream causing the PSA to rise. As the body cleans up from that event the PSA will fall again.

Radiation bounce happens. Your doc is right, wait for the next test, likely it will head down again.

Hang in there,
Andrew
Posted 10/8/2015 6:08 PM (GMT 0)
Question - did he have adjuvant hormone therapy after his salvage radiation, and if so, for how long? Also, how high did his PSA get before salvage radiation began?

- Allen
Posted 10/8/2015 8:59 PM (GMT 0)
He has only had the surgery and the Radiation the week before Radiation began he was 0.35, that was like March 28th of this year. Just on Monday it was 0.45. Dr said it was steady or declining? Which seems confusing since it is higher. I am asking all this because he has been very depressed and thinks the Cancer is going to come back. He has been told the Dr said don't worry, but he is out of the country right now and we cannot talk, only text. Just want lots of info so when he returns.
Posted 10/8/2015 10:56 PM (GMT 0)
Thanks for explaining. OK, I'd certainly want a confirming PSA, but let's say that the salvage radiation didn't get it all. What are his options now? He has three that I can see:

1) Begin hormone therapy immediately.
This would certainly control his cancer for now, but at the expense of his quality of life. There is no evidence that starting hormone therapy sooner has any survival benefit over waiting, and it may drive earlier resistance to hormone therapy.

2) Wait to begin hormone therapy.
Many oncologists advocate waiting until mets are detected, or there are symptoms, or the PSADT becomes rapid. This affords a quality of life advantage, and there is no evidence it harms survival. However, it is hard to "do nothing," and for some, the anxiety is unbearable.

3) Wait until PSA rises to over 2.0 ng/ml and get a PET scan then
Mets generally can't be detected if the PSA is under 2 or it is not rapidly rising. Bone scans generally can't detect mets if the PSA is under 10. Some of the newer PET scans can detect mets when the PSA reaches 2. Mayo offers the C11 Choline PET/CT, but check with your insurance first. There are several new PET tracers that may be a lot more sensitive that are in clinical trials, and may be free of charge.

There is a theory that such mets, if there are very few of them, can be treated with a few zaps of SBRT, which may halt progression for a while. It is not likely to be curative, but it may add to survival and quality of life - no one knows for sure. But the SBRT is not at all toxic, so it's hard to argue against this route.

- Allen
Posted 10/9/2015 12:23 AM (GMT 0)
The Dr said wait for 6 more months then do another PSA and go from there. He is sure it will go down. Thing is that the PSA was going up before they did Radiation but the Cancer was so small they could not find it anywhere with all the test so they just did the Rad. In the Prostate bed.
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