HealingWell
Search Close Search
☰

PSA rising after IMRT with Lupron

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/30/2017 12:37 PM (GMT 0)
70 yrs old very active
I had my radiation (IMRT 81 GY) with Lupron the first of 2016 for my T2c, Gleason 7 (4+3) prostate cancer. My testosterone returned by first of Sept. 2016 and I had my first post-Lupron PSA in Oct. 2016 with a reading of .2. My next PSA 4 months later Feb. 2017 was .3. I emailed Phoenix Molecular Imaging with my medical info and asked how high my PSA had to get before the C-11 Acetate PET/CT scan would pick up anything. They called back and said because of my "doubling time" of 8 months the scan would work now and set up a scan two weeks later. The scan ($3,000) showed a small tumor near the center of my prostate and he recommended action be taken in weeks as opposed to months. My Urologist poo-pooed the scan (which he never heard of) saying it would take a year or two for all the cancer to die. He said the rise in PSA was Bounce. My next PSA in June 2017 was .4. I bypassed my Urologist and went to a Cancer center supported by MD Anderson and spoke to the Radiation dept head doctor. I had the scan picture with me but he didn't want to see it. He said the PSA couldn't be trusted because of "Lupron Washout". He said that Lupron took a year or two to get completely out of my system. 3 doctors 3 answers.
Any thoughts?
Posted 7/30/2017 1:29 PM (GMT 0)
Urologists are not trained to be Oncologists which is who you need to see...Since your prostate gland was not removed, you will always have a little PSA...The Lupron can create an undetectable PSA test result but as it wears off you can expect an increase in PSA level. At some point within a two year time-frame you should reach "Nadir", a point at which your PSA stabilizes at a low level and will remain there indefinitely..Talk to your RO about it...
Posted 7/30/2017 1:29 PM (GMT 0)
A recurrence after RT is defined: "Biochemical failure is defined as a rise of 2 ng/mL or more above the nadir after EBRT w/ or w/o hormonal therapy." According to this definition you have no recurrence.

You could try to get the tumor detected with the PET/CT treated. However, I would suggest to wait until you have a recurrence according to the definition since there is no proof that treating the small tumor will help and the treatment can cause side effects.
Posted 7/30/2017 4:15 PM (GMT 0)
After my urologist, I went to 2 Radiation Oncologists. Neither one would not look at the C-11 results. I figured the C-11 scan plus the (old) ASTRO def of recurrence being 3 PSAs going up in a row would be enough. If my PSA continues to go up at the present rate, I'll meet the Phoenix def of recurrence by the end of 2018 and of course my C-11 scan won't be usable then.
Posted 7/30/2017 4:34 PM (GMT 0)
They were right not to look at your c-11 scans. I think you made a very expensive mistake in getting it so early. Your urologist is absolutely right - it takes a while for all the cancer cells to die after radiation. When you took Lupron, it artificially lowered your PSA. Now it is rising back to its normal level. It will be years until your PSA settles down to its nadir. It is a process, nerve wracking for some, that just takes time.
Posted 7/30/2017 5:31 PM (GMT 0)
On this web page the UCSF Medical Center writes:

UCSF said...
Though infrequent, it may take up to two to three years for the PSA to reach its nadir. Keep in mind that the PSA may not decline steadily. Temporary increases in PSA, also called "spikes" or "bounces," may occur during the first 12 to 36 months......

If you received hormone therapy, the PSA decline and the period of decline may be prolonged. As your testosterone recovers, your PSA may rise. This increase is not considered a "bounce or spike" and is not a sign of treatment failure.


George
Posted 7/31/2017 1:10 AM (GMT 0)
Thanks
Posted 8/3/2017 5:56 PM (GMT 0)
Having hip pain for the last three weeks is not helping.
Posted 8/3/2017 6:19 PM (GMT 0)
It is doubtful that PSA of.3 would be from a bone met that is causing hip pain. Look to other common causes.

It can be frustrating that it takes a while for the radiation to alleviate the cancer. Part of it is the inherent longevity of prostatic cells. They live much longer than most other cells and this carrys over to most PCa. Longer life and less frequent divisions favor the usually slower progression versus other cancers. It also means it takes longer to the eventual cell death. This is one of the reasons chemo isnt effective with PCa in the same way as most other cancers.
Posted 8/3/2017 8:47 PM (GMT 0)
You were on a short course of ADT. Done along with my primary RT, my ADT lasted 3 years, ending in March 2016. But your situation, and your mindset, sound quite familiar. Tall Allen makes some good comments there. The last year for me has indeed been rather nerve-wracking.

Beginning in May 2016, and lasting all the way until July of 2017, my PSA rose at an initially alarming rate, but showed a slowing trend. My testosterone returned to "normal" quickly, even better than baseline, and stayed there most of that time. Even so, the PSA didn't immediately jump up to a stable value but kept rising. As of July, it leveled off at 0.8; there is a good chance it could stay there a long time. That may be my true post-RT nadir value from the radiation. It just took a freakin' long time to get there. With any luck, it will just sit there as the ongoing output from my remaining irradiated prostate tissue.

If you look at literature, the meaning of PSA trends post-RT+ADT is just a huge question mark. I think that's why those smart guys developed the "Phoenix" criterion of recurrence, considered such if PSA increases 2 over the nadir, the lowest value. Based on earlier criteria, like 3 consecutive rises, I'd be considered in recurrence and spending money on scans and maybe even further treatment. In my case, that may have all been premature if I'd done that.

As it is, we'll just keep watching mine to follow the trend quarterly. It's really hard to do, but after radiation it is a long, drawn-out waiting game. As someone here said, it's a marathon run at a snail's pace!
Posted 8/4/2017 12:39 PM (GMT 0)
PSA fluctuation can be unnerving. The combination of radiation and hormone therapy can lead to some bouncing scores. Nadirs sometimes can be elusive, but it seems you are not close to 2 points over nadir. Radiation can take some time to work its magic. Good luck and wishing you well.

Regards,
Kris
Posted 8/4/2017 1:32 PM (GMT 0)
Waiting it is. After looking at all the salvage treatments available, the only one that that makes sense to me is focal HDR Brachytherapy. Since I wouldn't qualify for any of the trials since my radiation level of 81 Gy exceeds their acceptance levels of 78 Gy and Cryo and HFU have high incidence of side effects (incontinence) I choose to just wait and deal with whatever comes along. After 7 months of ADT, I can't picture going back on them. Thanks for the in put
Posted 8/4/2017 3:21 PM (GMT 0)
Salvage treatment would only apply to the prostate area. This is rarely needed after radiation therapy as it covers a larger area than surgery does. And you had extensive radiation including the pelvic nodes.

More often if the cancer continues to grow after radiation, it is because some was already outside the area of treatment and thus systemic. Then you have to use systemic treatments like ADT. I think you are too early to consider that now and have not reached the point that would indicate additional treatment. Also you are entering the time that a PSA bounce can be expected due to the radiation induced cell deaths.

Nothing to do now but continue to monitor the PSA. If, and when a pattern emerges that requires further treatment, your docs will make the relevant suggestions.
✚ New Topic ✚ Reply