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PSA after radiation only

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Posted 12/8/2015 3:25 AM (GMT 0)
Need some help for those that haven't had surgery and perhaps only radiation. I only have experience with having surgery and the goal is to have an undetectable psa after surgery. So, what should the psa be if you've done only radiation? Should it be undetectable or does some tissue still produce psa. Thanks.
Posted 12/8/2015 3:53 AM (GMT 0)
Radiation leaves the prostate behind and only kills the cancer cells. That's the theory. Some of the prostate is damaged.

PSA post RT won't become undetectable, but it will go low. The lowest point, known as nadir, is reach after a year or two after treatment. The absolute number isn't all that important. The important part is going low and staying there.

Andrew
Posted 12/8/2015 5:40 AM (GMT 0)
Like everything else PCa, it varies by individual.

Mine was not radiation only but rather SBRT and Provenge and PSA has been undetectable for over a year.

My heavily radiated prostate has not been removed. This was initial treatment, not post-surrgery.

PSA has never been a very reliable indicator for me as even though I was G9 (4+5) at initial diagnosis, max PSA was 3.68.

It was PSADT that on consecutive semi annual tests went from 1.7 to 2.62 to 3.68 that drive the biopsy
Posted 12/8/2015 12:19 PM (GMT 0)
What range can the nadir be? Is like .5 ok or just depends I guess. The guy I know had radiation and I think the doc put him on IHT to keep his psa undetectable and has done this for like 15 years. I'm wondering if the Lupron has masked a good thing...meaning he probably doesn't need therapy. His psa is went from .1 to .5 in a 6 months, but I'm thinking this is a lot different than if he would have had surgery.
Posted 12/8/2015 1:34 PM (GMT 0)
If the PSA went up that much it could indicate there was still cancer somewhere that was advancing, thus the HT would be appropriate.

Generally after radiation you want to see PSA at .2 or less to consider a cure. However, since the prostate is still there it will emit PSA so the absolute number is not as important as the trend. As long as the PSA is stable, no other treatment would be warranted. But if the PSA starts trending upward it signals there may still be cancer and warrants further treatment.
Posted 12/8/2015 2:44 PM (GMT 0)
Thanks. That's what's tricky. I think every time it's gone up he's gone on HT....never waiting for trend.
Posted 12/8/2015 5:38 PM (GMT 0)
An excellent result is .2 or less. Dattolli has had patients with a psa as high as 6 with no cancer detected. AS long as the psa is reduced and is stable (not rising), then it counts as a cure.
Posted 12/8/2015 5:45 PM (GMT 0)
Reoccurrence post RT is generally defined as a PSA of nadir + 2. RT folks can tolerate much wider swings in PSA before needing to get further treatments.

Andrew
Posted 12/8/2015 6:31 PM (GMT 0)
Mine has dropped from 4.6 to 1.3 in a year and my RO is happy. Like others have said, part of my prostate is still 'working'.

This might be TMI, but this past weekend I had more ejaculate during sex than at any point post HDR - and it's been a year. It was actually a pretty respectable amount, considering I have been disappointed in that part.

I guess those with the prostate removed have none, right?
Posted 12/8/2015 6:38 PM (GMT 0)
I had radiation with HT as my primary therapy, and am just now finishing up 3 years on HT.

My G9 case wasn't indicated very well by PSA either. Based on the MRI indicated tumor size, and the biopsy percentages, mine should have been about 4 times what it measured. Type 5 cells don't make a lot of PSA, so if one's PCa has a lot of those then PSA is a less effective tracking tool.

My MO said when my HT wears off in about 4 months, that as testosterone recovers the PSA may also rise. However, the big thing is the trend. So if it goes up as the T goes up, but levels off somewhere below 2 or so, we won't worry. If it continues to trend up past 2 at some point, then we will consider further treatment. I am planning on NOT doing any more treatment!
Posted 12/8/2015 11:21 PM (GMT 0)
Dewayne,

Yes...that is correct. Surgery guys produce none.

Thanks everyone...
Posted 12/9/2015 4:20 AM (GMT 0)
If it eventually reaches 0.5 or less, it's correlated with low BCR . It can always bounce around, so a change from .1 to .5 should not have raised any red flags and should not have triggered ADT treatment according to any standard of care I'm aware of. As Andrew said, the time to worry is when it hits nadir + 2.0, and then, the next step would be an mpMRI-targeted biopsy to see if it's a localized recurrence amenable to salvage treatment - not ADT. Was the doctor who did this a radiation oncologist?

- Allen
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