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Rise in PSA 6 years after RT

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User
Posted 26 Jan 2024 at 09:49

(posted as a new topic as replying to one of my much earlier posts didn't get any comments)


I have not posted recently as all seems to have been going well. But for the last couple of years my PSA has started to rise from the 0.48 or so after I finished RT in 2016. I had my last PSA this month and this week the follow up telephone appointment from the consultant - this time the head of the department rather than her minions who usually call. PSA was 2.3 last July, it has now risen to 3.0. She didn't seem too concerned, noting that it is the rate of change rather than the actually value, which was important, but a 40% or so rise in six months seems a lot to me. When it initially started to rise it was suggested that they would do more tests when it got to 2, and I did have scans 18 months ago which showed all was well. She is now saying they will not do anything more unless it rises to 5 and I will have another PSA in six months.


I have no symptoms, no aches or anything. Urine flow remains reasonable at 2 to 3 visits during the night - she said that might not be related to the cancer anyway, just an enlarged prostate (King Charles take a bow..). Generally still in good health and doing weekly long walks in London.


Should I be worried?

User
Posted 26 Jan 2024 at 09:49

(posted as a new topic as replying to one of my much earlier posts didn't get any comments)


I have not posted recently as all seems to have been going well. But for the last couple of years my PSA has started to rise from the 0.48 or so after I finished RT in 2016. I had my last PSA this month and this week the follow up telephone appointment from the consultant - this time the head of the department rather than her minions who usually call. PSA was 2.3 last July, it has now risen to 3.0. She didn't seem too concerned, noting that it is the rate of change rather than the actually value, which was important, but a 40% or so rise in six months seems a lot to me. When it initially started to rise it was suggested that they would do more tests when it got to 2, and I did have scans 18 months ago which showed all was well. She is now saying they will not do anything more unless it rises to 5 and I will have another PSA in six months.


I have no symptoms, no aches or anything. Urine flow remains reasonable at 2 to 3 visits during the night - she said that might not be related to the cancer anyway, just an enlarged prostate (King Charles take a bow..). Generally still in good health and doing weekly long walks in London.


Should I be worried?

User
Posted 27 Jan 2024 at 00:35
Hi,

Yes different range of figures apply for men having Prostate and RT because a radiated Prostate will still produce some PSA.

Based on what we are told, I would also advocate a second opinion and a PSMA scan. There was a time when after radiation nothing was considered until PSA reached around 10 but the PSMA scan has meant that it is sometimes possible to find cancer earlier and further afield. A high quality MRI scan often enables residual or growing cancer to be identified in the Prostate.

Do let us know what you decide and with what result.
Barry
User
Posted 27 Jan 2024 at 08:33

Thanks for the comments. Last year it was just a CT scan and a bone scan even though I was expecting an MRI. I will have a think what is best to do, and maybe insist on an in person appointment since all the ones after lockdown have been telephone only.

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User
Posted 26 Jan 2024 at 23:43

Hi,


From what I've seen an increase of 2 above the nadir or 3 increases in psa should be investigated.  Did you have a psma scan or an mri last year.  A psma scan can see smaller lesions and that should be preferred.  Some places don't like spending the money as they haven't got a psma scanner.


I've no experience of RT but if it was me I'd be looking for another opinion. Perhaps a PCUK nurse by phone or ask to meet an Oncologist at the hospital. Perhaps a private second opinion.


I was told I could have a psma scan at 0.5 on the NHS if it reaches that, after surgery. Also I could pay for one earlier.


There are more treatments available,, such a focal,  and I wouldn't want to miss out because it got too high.  If it rose by a third in 6 months it could become 4 by July and 5,2 by next Jan although you can't forecast accurately.


I wouldn't normally reply to an RT type query but I noted you said no-one replied to your last post. I had my treatment, surgery, around the same time as you and have been on here 7yrs so picked up some stuff and perhaps someone else will answer. All the best Peter

User
Posted 27 Jan 2024 at 00:35
Hi,

Yes different range of figures apply for men having Prostate and RT because a radiated Prostate will still produce some PSA.

Based on what we are told, I would also advocate a second opinion and a PSMA scan. There was a time when after radiation nothing was considered until PSA reached around 10 but the PSMA scan has meant that it is sometimes possible to find cancer earlier and further afield. A high quality MRI scan often enables residual or growing cancer to be identified in the Prostate.

Do let us know what you decide and with what result.
Barry
User
Posted 27 Jan 2024 at 08:33

Thanks for the comments. Last year it was just a CT scan and a bone scan even though I was expecting an MRI. I will have a think what is best to do, and maybe insist on an in person appointment since all the ones after lockdown have been telephone only.

User
Posted 27 Jan 2024 at 09:02

Hi Dave,


This is what I worry about in the future…that following RT my PSA will at some point rise and I may be on ADT for life. Do you mind me asking how long you were on ADT? I’m on it for 3 years, 9 months before RT and the rest after it, and if you been following me joint ache is now really affecting my QOL.


I hope you can get a satisfactory outcome. Do you have a CNS you can speak to? Mine are execellent.


Derek

User
Posted 27 Jan 2024 at 09:46
I was on hormone therapy for just six months before RT, it was decided not to continue afterwards. I did have a CNS for a while and during RT but have not had since and have lost touch with them, the original was based at the urology hospital not the oncology where I had treatment.
User
Posted 27 Jan 2024 at 11:27

Reading these posts it shows the difference in oncologists, in June last year my PSA was 0.49, in December it was 2.12.  I didn’t think she would worry to much about that.  She arranged for me to have a CT scan and nuclear bone scan which I had last Tuesday.


Arthur

User
Posted 27 Jan 2024 at 16:28

DH had brachytherapy 9 years ago. PSA went down to 0.01 where it stayed for many years. About 4 years ago it started to increase. Slowly at first. Consultant said he would see dh when it got above 2.1 DH phoned through his result when it was at 2.0. He still said no but to test in 3 months. 3 months later it was 2.7 so he had an MRI nothing showed, consultant said no cancer in prostate, so brachy had worked, however psa was now 3.7 So suggested DH had a psma scan, plus another psa test that came back at 4.9 so it was increasing quickly. The psma scan showed cancer cells in the lymph nodes in his pelvis and chest. I’ve still no idea how it gets into the lymph nodes further away without being in the nodes near the prostate. Gleason was 3+3 which apparently doesn’t spread. So who knows? So I would insist on a psma scan if you can. Your psa isn’t increasing very fast though, so hopefully all is ok. 


 

 
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