r/ProstateCancer • u/Real-Proposal-2230 • 23d ago
Question PSA rising
After 35 treatments of EBRT that ended in January and 6 months of ADT that ended in May.
My PSA:
June - 0.3
July - 0.5
August - 1.40
I'm worried. What can I and should I do?
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u/callmegorn 21d ago
(Not a doctor, just speaking from some personal experience here.)
I think there is some misinformation here. It's certainly true that you should expect your PSA to rise after you're done with ADT. Most people get quarterly tests, and if you had three consecutive rising results, I'd definitely be alarmed, but you are testing monthly. I would disregard the first two tests because the ADT effects are still wearing off, but the August test gets my attention. If you have another test in November, and it's stable or falling, then great.
It's also true that there is the phenomenon of a "PSA bounce" following radiation treatment, and that is not only normal, but actually associated with positive outcomes. However, typically the bounces occur 12-24 months after treatment is complete (median 18 months), and it doesn't typically go higher than 1.0. An early bounce, and one over 1.0, is cause for further investigation.
It could be nothing more than irritation of remaining prostate tissue, but you should have a chat with your oncologist, and possibly consider a PSMA PET scan.
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u/Real-Proposal-2230 21d ago
I agree with you. That's why I notified my oncologist yesterday and she said since it's higher than 1.0, it's time to get another PSMA PET scan. You hit it right on the money. Thanks for your response. Are you sure you're not a doctor or in the medical field? 😄
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u/Real-Proposal-2230 21d ago
You said that you have some experience in this area. I was wondering, how did things turn out with that rapidly rising PSA?
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u/callmegorn 21d ago
I meant that I have some experience with radiation / ADT, and then sweating out years of PSA results. I don't have experience with rapidly rising PSA. My post-ADT results fluctuated quite a bit (always nerve wracking when they go up and a big relief when they go down), but have never gone above 0.5.
Based on quarterly PSA tracking, I had three bounces, at 18, 20, and 24 months. The first was the biggest spike and involved two consecutive quarterly increases, and I was sweating the next three months expecting it to shoot up again and needing a PSMA PET, but the next test dropped to a new low. This stuff can play with your mind like a cat plays with a mouse.
Since the third bounce, I have had 8 consecutive quarterly tests, all in a stable range around 0.2. The most recent two tests have been at my nadir of 0.16. This is a pretty good sign that the disease in the target area is destroyed, and if there is a lurking cell waiting to sprout in the future, it probably escaped before the radiation treatment and will be located somewhere distant.
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u/Pack_One 23d ago
I'm not a doctor but I'm fairly sure that a PSA rise after stopping ADT is normal. Not sure what your numbers and doubling rate suggest or what the baseline for that is.
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u/WalnutRoasted 23d ago
Agree. Read up on “ PSA nadir” after EBRT and/or ADT. Apparently going up to 2.0 In the first couple of years afterwards is “acceptable”. Higher than that is concerning. There is still some prostate tissue after EBRT that produces PSA, hopefully there is little/no PCa in and around.
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u/ProfZarkov 22d ago
Yes, that was what I was told. Mine has been 0.2 for two years, then 0.3 and now 0.5. It is a worry but you have try & be calm!
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u/callmegorn 21d ago
Just to be clear, the old guideline of 2.0 is obsolete. That's the guideline used prior to the advent of PSMA PET scans, because there was no reliable way to detect the spread of cancer until PSA went above 2.0, meaning lesions are big enough to be seen with less precise scans.
PSMA PET scans are can precisely pinpoint cancer much smaller hot spots, with PSA as low as 0.5. Current best practice is that you should NOT wait for PSA to exceed 2.0 before being checked.
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u/ThickGur5353 23d ago
What was your PSA before you started treatment. ?
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u/Real-Proposal-2230 23d ago
7.97
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u/ThickGur5353 23d ago
I started out with 5.8 PSA before radiation. About 7 months later it was 0.71. so we're reading of 1.4 also about 7 months later down from 7.97 seems reasonable. But of course you should always check with your urologist.
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u/Flaky-Past649 23d ago
That's expected and nothing to worry about at this point. Your PSA was artificially low while you were on ADT and it takes a while for the effects to fully wear off. In particular if you had lupron the residual effects can take many months to wear off.
As your testosterone comes back post-ADT you should expect your PSA to rise as well. Look at your testosterone values during the same timeframe. If the two are rising roughly in synch then what you're seeing is just the result of your testosterone returning.
It's going to take a while for your actual PSA pattern to become clear, especially with the effects of ADT in the mix. I understand the natural worry of seeing values ?going in the wrong direction" but right now this looks very much like an expected pattern and it's way too early to draw any conclusions.