First post, questions about 1st PSA after 44 IMRT tx

My first post to the forum here though I've been following it for about a month now, I wish I had found this forum several months ago.

I have some questions about my first PSA since my IMRT treatments finished up on April 17, 2017.

I'll first give some history:

Aug. 19, 2016: diagnosed with BPH via DRE (right side found to be enlarged), and had PSA test
Sep. 21, 2016: Met with urologist and got results of Aug. 29 PSA test, PSA=71.4
Sep. 23, 2016 to Oct. 02, 2016: 10 day course of antibiotic (BACTRIM) to try to reduce PSA in case it was elevated due to infection.
Oct. 03, 2016: PSA diagnostic, PSA=87.3
Oct. 12, 2016: TRUS Biopsy
Oct. 14, 2016: Biopsy results: T1C; Gleason 7 (4+3); Volume 31cc; left side 3 of 6 cores +; right side 0 of 8 cores +
Nov. 08, 2016: Bone scan, no mets detected
Nov. 11, 2016: Two week course of Bicalutamide started
Nov. 22, 2016: First 6 month LUPRON injection
Jan. 23, 2017: Fiducials placed for IMRT
Feb. 08, 2017: CT/Simulation planning session
Feb. 15, 2017 to Apr. 17, 2017: 44 IMRT tx, 1st 25 sessions - Whole Pelvic radiation 45 Gy, last 19 sessions - Prostate Boost 34.2 Gy, total 79.2 Gy
May 16, 2017: 2nd 6 month LUPRON injection
Aug. 25, 2017: PSA diagnostic, PSA=<0.1 ng/mL


As you can see my primary treatment has been 44 IMRT sessions. I had 12 weeks of neoadjuvant ADT before radiation. Was on ADT during radiation. And will receive 24 months of adjuvant ADT after the radiation.

My question is, has my PSA come down to the <0.1 level too quickly?

I suspect that the ADT/lupron has something to do with it. If recall correctly, when I met with RO after my last IMRT session I think he did say something to the effect that the ADT I'm on might mask what's really happening and the PSA's don't really mean a lot while I'm on the ADT.

I have my first followup visit with my RO this coming Tuesday (Aug. 29).

Kent

Welcome to active posting. It looks like you had your first Lupron shot last November, but I don't see any mention of PSA testing until this month. I'm guessing they were probably doing PSA tests earlier on (but you didn't include in your list). If so, what was your PSA a few months after the first Lupron shot? That likely would have been close to zero even though it was before your IMRT.

Even though you're on ADT, you probably want to keep checking your PSA since it lets you know the Lupron is working. Ditto for a testosterone test to make sure the level is low.

Good luck with your RO appointment. As Andrew says, your numbers are right where you want them to be right now!

Kent, your treatment mirrors mine pretty closely.

I was on HT for 3 years. When it ended, my PSA and testosterone (T) began a slow rise over the course of more than a year. The T recovered quickly, achieving better than baseline level in about a year. The PSA rose alarmingly at first, increasing at a slower rate each quarter. Finally, at about 16 months it finally leveled off at 0.8. I'll check again in October, but I expect it to be the same value. It followed a math projection called a Gompertz curve, limiting to a maximum value.

As others said, your PSA while on ADT is only to confirm the T is still low. It will mask the radiation bounce you'd otherwise possibly see. This is a marathon run at a snail's pace. The PSA pattern for your situation is really a large gray area, and no one has any very good answers. All you can really do is ride it out. Follow the trend as well as the numbers, and remember you are a person, not a number. Your doctor will follow with you, and will hopefully help you navigate the uncertainty around the recovery phase.

If you're interested, I could talk your ears off about this. I went pretty deep into it over the previous year or so!