Debbie,
Testosterone is the hormone that activates the prostate, causing both cell growth from puberty, and the cells to produce PSA, the main product of the prostate. PSA is one of the components of semen. In a healthy prostate, the cells are arranged such that the PSA collects in the ducts of the prostate, and only a little leaks into the blood. Cancer cells are not arranged correctly and the PSA they make isn't collected in the ducts, and ends up leaking into the blood in larger amounts, hence pushing up the PSA level in the blood.
Hormone therapy is given to switch off the prostate cells during radiotherapy, and for a period before (neoadjuvant) and afterwards (adjuvant). It does this by stopping testosterone, which switches the cells off, preventing growth, and preventing PSA generation. It turns out that if you prevent prostate growth during radiotherapy, the outcomes are significantly improved. This is why PSA drops when you are on hormone therapy, and measuring PSA is a useful indicator of just how 'switched off' the prostate is.
The radiotherapy should kill all the cancer cells in the prostate, but ideally doesn't kill non-cancerous cells. Many people don't realise that radiotherapy is selective and imagine it's like microwaving their prostate for 5 mins on full power, but that's absolutely not the case. After the radiotherapy, the cancerous cells will either be dead, or badly enough damaged not to be able to grow new cancer cells. There will be some collateral damage to non-cancerous cells too (that's what causes radiotherapy side effects), but most will survive.
When you come off hormone therapy, your testosterone will hopefully come back, but it takes time. Usually nothing happens for a while, but then it comes back over a period 3-6 months. When this happens, your prostate cells will switch back on and they will start producing PSA, which is their main function. Even healthy cells leak a little PSA into the blood, forming the "normal" PSA level, and your PSA level will rise back to that. It looks to me like this happened from February to now in your case, perhaps 12 months after stopping hormone therapy, which is not untypical.
If you had testosterone readings too, you could confirm that the PSA rose as the testosterone did. Given that you don't, and we expect to see the PSA rise to normal levels, and it has, we can assume that this is when your testosterone recovered. Furthermore, this is in line with typical timescales for testosterone recovery after hormone therapy ceases.
This doesn't confirm that the radiotherapy did get all the cancer - it's too soon to know that. But what you're seeing so far is entirely expected. If the PSA rises above 2.1 in your case (2 more than the minimum after treatment), then that would start raising concerns that there might be some cancer left, but I don't see any cause for alarm now. I think what you are seeing is entirely expected.
Edited by member 29 Aug 2020 at 04:08
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