I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Raised PSA post RT - Hormone therapy (HT / ADT / IMHT),Radiotherapy (EBRT / IMRT / Proton),psa raised

Email this conversation Print this conversation
User
Posted 17 Feb 2018 at 12:33

Hello All

My husband has just had the result of a PSA test taken 8 months after EBRT (and 6 months after cessation of hormone therapy; he was having combined treatment). 4 weeks after RT his PSA reading was 0.15 (still on hormone therapy at that point). It's now 1.16. The onco nurse is clearly concerned and has asked him to retest in 10 days. So, we wait. Meanwhile I'm all over the place with working out what this could mean. I know one PSA test in itself can't tell you much. But as far as I understand, this reading could mean any of the following: urinary infection or prostatitis (he has/had no symptoms of either), random mystery blip, existence of aggressive cancer. Anyone got perspectives to offer, including what we might expect next in terms of testing/ waiting? TIA

User
Posted 17 Feb 2018 at 21:04

Once RT is finished and the hormones are out of his system, a man's PSA should stay around 1.0 or less but isn't considered to be a biochemical recurrence until it goes over 2.0. You would expect to see the lowest reading (nadir) about 18 months post RT - this early after the treatment is too soon to assume it has failed. Having said that, men are usually on HT for much longer than 6 months these days so depending on the next PSA test it may be that the nurse recommends you see the onco again just to discuss whether another period of hormones could be a good idea.

Edited by member 17 Feb 2018 at 21:06  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Feb 2018 at 16:00
Hello Jan

These PSA tests are always a worry but it sounds like you have a proactive nurse who is keen to re check.

Yes the PSA can fluctuate for the reasons that you mention and need to find their level - around which hopefully they will hover for many years.

You are doing the right thing checking and I hope that the result is stabilized.

I'm no expert - and others please correct me if I'm wrong - but if it is an increase and is confirmed by the next test - the treatment would be to go back on the hormone treatment.

My OH had Radiotherapy and then HT for a further 3 years so your husband has come off it a lot sooner - maybe treatments have changed a little.

Kind regards

Alison

User
Posted 17 Feb 2018 at 18:55
Hi Janet,

I finished the identical treatment to your husband end September. I have been reading Dr Patrick Walsh, Prof of Urology, Johns Hopkins Med Inst, book, who identifies this occurrence after combined HT/RT treatment.

Hopefully it’s what he calls a ‘PSA false rise’ after the hormones have left your husband’s system while the effects of the RT continue to take effect.

He explains it as the low PSA after treatment being artificially low, a result of low testosterone, because of the HT.

As the hormones exit the body approx. 6 months after the HT expired, PSA rises, but then the effects of the RT continue to develop and the PSA then starts to drop to it’s lowest point. He states the RT effect can take 2-6 years to reach it’s maximum effect.

Also after RT there is ‘PSA bounce.’ He states this can happen about 9 months after treatment to about 1/3 of men. He says it’s a sudden rise of 0.5 to 1 ng/mL followed by a drop back down.

He quotes another authority, Dr Song, “ironically, men who develop a PSA bounce ultimately have a better disease-free survival rate than men who did not have a bounce.”

So fingers crossed this is what it is.

Keep us posted.

G

User
Posted 28 Feb 2018 at 08:49

Reassuring news after more tests - OH's testosterone level has returned back to 'normal' after 6 months off hormone blockers (at 25nmol/l), which apparently accounts for the rise in PSA, as Graham indicated. Two weeks on the PSA has dropped a bit too - 0.98 now. Onco nurse says all is now on track for this stage of the process; he'll have another PSA test in 3 months. 

Many thanks for the responses - this is such a generous group of people willing to share info and experience. It really helps. 

Show Most Thanked Posts
User
Posted 17 Feb 2018 at 16:00
Hello Jan

These PSA tests are always a worry but it sounds like you have a proactive nurse who is keen to re check.

Yes the PSA can fluctuate for the reasons that you mention and need to find their level - around which hopefully they will hover for many years.

You are doing the right thing checking and I hope that the result is stabilized.

I'm no expert - and others please correct me if I'm wrong - but if it is an increase and is confirmed by the next test - the treatment would be to go back on the hormone treatment.

My OH had Radiotherapy and then HT for a further 3 years so your husband has come off it a lot sooner - maybe treatments have changed a little.

Kind regards

Alison

User
Posted 17 Feb 2018 at 18:55
Hi Janet,

I finished the identical treatment to your husband end September. I have been reading Dr Patrick Walsh, Prof of Urology, Johns Hopkins Med Inst, book, who identifies this occurrence after combined HT/RT treatment.

Hopefully it’s what he calls a ‘PSA false rise’ after the hormones have left your husband’s system while the effects of the RT continue to take effect.

He explains it as the low PSA after treatment being artificially low, a result of low testosterone, because of the HT.

As the hormones exit the body approx. 6 months after the HT expired, PSA rises, but then the effects of the RT continue to develop and the PSA then starts to drop to it’s lowest point. He states the RT effect can take 2-6 years to reach it’s maximum effect.

Also after RT there is ‘PSA bounce.’ He states this can happen about 9 months after treatment to about 1/3 of men. He says it’s a sudden rise of 0.5 to 1 ng/mL followed by a drop back down.

He quotes another authority, Dr Song, “ironically, men who develop a PSA bounce ultimately have a better disease-free survival rate than men who did not have a bounce.”

So fingers crossed this is what it is.

Keep us posted.

G

User
Posted 17 Feb 2018 at 21:04

Once RT is finished and the hormones are out of his system, a man's PSA should stay around 1.0 or less but isn't considered to be a biochemical recurrence until it goes over 2.0. You would expect to see the lowest reading (nadir) about 18 months post RT - this early after the treatment is too soon to assume it has failed. Having said that, men are usually on HT for much longer than 6 months these days so depending on the next PSA test it may be that the nurse recommends you see the onco again just to discuss whether another period of hormones could be a good idea.

Edited by member 17 Feb 2018 at 21:06  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Feb 2018 at 08:49

Reassuring news after more tests - OH's testosterone level has returned back to 'normal' after 6 months off hormone blockers (at 25nmol/l), which apparently accounts for the rise in PSA, as Graham indicated. Two weeks on the PSA has dropped a bit too - 0.98 now. Onco nurse says all is now on track for this stage of the process; he'll have another PSA test in 3 months. 

Many thanks for the responses - this is such a generous group of people willing to share info and experience. It really helps. 

 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK