Rising PSA After Brachytherapy - Benign Bounce or Recurrence

Five years after brachytherapy, my PSA has quadrupled in a year from 0.4 to 1.5. It indicates possible recurrence.

In March 2011, I was diagnosed with T1c prostate cancer with a Gleeson score of 3 + 3. At the time of diagnosis my PSA was 3.4 On June 20,2011 I had seed implant. By September 2011, my PSA went down to 1.1 and by December 2012 it reached a lowest value of 0.1. By June 2013, it bumped up to 0.2 and settled back to 0.1 by December 2013. Then it started rising slowly to 0.2 by June 2014, to 0.3 by December 2014, and to 0.4 by July 2015. Then jumped to 1.5 by July 2016. It appears that I had a small PSA bump two years after brachytherapy. Next from the lowest value of 0.1 in December 2013 it started rising. Until last year the doubling time was one year. For last year the doubling time is six months.

In one definition of bio-chemical failure is three consecutive rise in PSA (irrespective of absolute value). According to this definition, I have recurrence of PC. Another definition is rise of 2.0 from the nadir (lowest value) constitutes a failure. I do not yet have recurrence as of now.

When I contacted my RO (who performed the implant), the RO nurse told me that the doctor thinks it is benign bounce (using doctor's term for the bounce). I have been given a prescription for another PSA in January 2017 followed by an appointment with the RO.

On August 10, I have an appointment with my urologist. I intend to show him my 12 year record of PSA. I have to wait and see whether he considers this as benign bounce or recurrence.

I would like to have advice on course of my action, particularly from people with similar experience. I know I can probably wait until I see my RO in January. But assuming that it is recurrence, I would like to plan my future treatment options. This board has been very helpful during initial diagnosis and treatment. I am very grateful to have valuable advice from various members.

If you look at the BT signatures on this forum you will see odd bounces all over the place. Some have had up to three bounces that happened over several years. I am going to vote bounce and your next PSA reading a downward trend.

I would also heed the Veteran member's advice to rule out a lab error.

They changed the definition of biochemical recurrence for the very reason that too often, the consecutive rises were defining patients as biochemically recurrent who were not clinically recurrent. That's why they adopted the Phoenix definition of nadir+2.

There may be benign causes for this bounce, like prostatitis, or an obstruction causing increasing urinary retention. You should talk to a urologist about investigating those, especially if you have urinary symptoms (e.g., stop-and-start stream, getting up to pee at night, etc.)

If you rule out other causes, and continue to rise to nadir +2, the next step would be some imaging and a prostate biopsy. If they find some cancer and a cold spot, they can simply re-treat the cold spot. Focal salvage ablation (cryo or HIFU) can be used. Recently, one RO has used focal salvage SBRT.

- Allen

Sounds like a good plan. Best to get a good set of labs.

Hang in there and keep us updated on your progress,
Andrew