Brachytherapy & Recurrence

I assume your references to surgery describe brachytherapy and not actual prostate surgery.

It appears that you might be rushing things a bit as the conventional recurrence criteria is for your PSA to be 2.0 points above the lowest value measured which would be 2.8 if 0.80 was the lowest value measured after treatment.

If you have been having PSA’s done regularly since 2018, you should be able to plot them up and get some idea of what they are doing over time such as doubling time. Given your age, hormone treatment at some future time would probably knock the PSA back down then you would wait for it to rise again then knock it back down again.

My 93 year old father had LD brachytherapy in 2003 and his PSA started rising slowly 4-5 years ago so went on Lupron for a year or so which knocked it down and has been off it for at least 3 years now. His PSA is creeping up again but not to the point where anyone wants to do anything yet.

Not sure what else can be done unless a scan provides a different target for radiation but you will have plenty of time to visit with oncologists and come up with a plan if an when your PSA keeps rising.

You could just be having the very common post-radiation PSA bounce. This often occurs in the 18-36 month time frame, which you are within. It is thought to signal the remaining PCa cells that were not originally killed finally dying and giving off a burst of PSA.

Post-radiation recurrence is defined as PSA nadir plus 2.0. For you, based on the information you have provided, that would be 2.80. So you are well away from that. Most radiation men don’t reach nadir for 3-4 years. You are just now three years from the treatment.

Did you have BT alone, or accompanied by external radiation?

As far as scans looking for any cancer, you may want to investigate some that are much more sensitive than a CT. Also, I would not be relying on any urologist regarding additional radiation treatment. Only get an assessment from an expert radiation oncologist well experienced with such treatments.

I am very grateful for all your responses. Some excellent information. To date the only treatment has been the Brachy. Since the surgery, if it is surgery, I have been having blood work for PSA every six months. What prompted me to act was the trend.

My original urologist has been so busy he had an assistant meet with me which was not satisfactory. The oncologist did not respond to three different requests for information. Add to that they are both an hour and a half from home, a potential problem in the winter, I decided to seek a doctor closer to home who works in a new cancer center in Truckee.

Again, thank you all for taking the time to write. You have put my mind at ease. I will report what I learn from my March doctor's session.

CT Scan performed 01/15/2021. Mildly enlarged prostate. No suspicious changes for metastatic disease. No evidence for distant metastases.

Early march I will be meeting with my urologist to discuss findings and suggested next steps.

Given my November PSA was 1.37 I do not expect any actions beyond routine tracking. I see the accepted range for PSA is 0.0 to 4.0.

I found my PSA records with the first being 1997. Then annually until 2012. No idea why the doctor stopped requesting. I finally asked for PSA reading 2017 and it was 5.0. My first post is a record of what happened next.

The reason for my recently seeing the urologist was the PSA number trending up since the surgery 2018. I believe in preventative maintenance.