How long does SRT take to work? - Localised cancer - Prostate Cancer UK Online Community

User

Posted 10 Feb 2017 at 21:25

Hi folks

Post surgery where PSA dropped to <0.02, it went up to 0.1 so SRT was on.It was possibly higher than that by the time RT started, maybe even 0.2. I am now just under 9 weeks since the 20 sessions finished. PSA came back today at 0.1. I don't see the consultant till Monday week. Ive heard RT can take a while to give the full effect. Can the PSA still drop further, and over what sort of time scale,or am I stuck with some cells that were missed?

Thanks

Edited by member 13 Feb 2017 at 19:37 | Reason: Not specified

User

Posted 11 Feb 2017 at 11:36

Hi both read my profile.

Post RP PSA was 0.06 in March 2013 By July 13 this had risen to 0.087. So I had 20 sessions of RT Aug/Sept 13. My oncologist wouldn't test the PSA for 6 months. So in March 14 it was about 0.047 (can't remember exactly).
Anyway to cut a long story short at each 6 month test it dropped a bit further until in March 16 it had reached 0.01. In Nov 16 it was 0.02 but that is probably i blip (will know more in March)

So yes it can take a while to drop. In my case 2.5 years

Bri

User

Posted 11 Feb 2017 at 14:17

The expectation is that you will reach your nadir (lowest reading) around 18 months after RT, regardless of whether it was salvage, adjuvant or radical treatment. If you are on HT, it is a rather different matter.

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

User

Posted 11 Feb 2017 at 10:12

Hi David my PSA was very similar to your reading prior to ST 0.2 which I completed in Aug 16 . I was advised to have my PSA just prior to my first Consultant review this week nearly 6 months to the date my PSA is now 0.1 so like you will have to wait a few more months to see how its going. Someone advised me that it can take up to 18 months for the levels to adjust to give an accurate reading. Good Luck

User

Posted 11 Feb 2017 at 14:23

I had 20 sessions of salvage RT in January 2016 when my PSA was 0.13 - over the past 12 months it has fallen to 0.06, 0.03 and latest result two weeks ago was less than 0.02 so undetectable.

Hope this helps reassure you that it takes a bit of time.

User

Posted 11 Feb 2017 at 18:18

Gosh I can't believe how helpful that has been- thanks guys!

All the time waiting for the 'likely' result but no 'guarantee' that the RT would be successful (maybe not for ever but at least a while!), I have been going mad with worry that it wouldn't be lower than the 0.1 /0.2 at start of treatment. Then it came back as 0.1 I'm thinking is that from stuff in the prostate bed....or much worse is it because of something OUTSIDE the bed....and therefore hormones and all that hell beckoning rapidly.

OK, I know it could still be bad, but you have helped me a lot for now!

David

User

Posted 11 Feb 2017 at 18:35

Thanks for this thread David.

I was sure that I had read that it could take 18 months or so to reach a nadir and so I didn't bother phoning for my last PSA result. I finished 33 sessions of SRT in June 2016 and I have a meeting with the onco in March following another PSA test a few days before. PSA at start of SRT was 0.5 and the first PSA following was 0.6 but being told about the 18 months took away the apprehension. The responses to your thread have confirmed that it's not worth worrying at the moment.

Thanks everyone 👍

Kevan

User

Posted 12 Feb 2017 at 11:55

Originally Posted by: Online Community Member

Hi, does it take 18 months to reach your lowest PSA after radiotherapy, not just salvage radiotherapy. 4 months after my OH finished radiotherapy the PSA is 1.3 , he is also on prostrap.

Sheila

Hi Sheila, slightly different when the man is on hormones as the HT keeps the PSA low. But the RT will continue to work to damage the cancerous cells for up to 18 months.

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

User

Posted 27 Feb 2018 at 11:18

Thank you Andrew for that helpful response.

Looks like your 'undetectable' was done using the basic test ie <0.1 rather than the Sensitive test that can show <0.02 ? Yes, it's all a waiting game. Obviously 0.11 is relatively a very low reading as such, and not a danger; it all depends on the speed it grows from now on...or just maybe drop again or stabilise.
When I was diagnosed 2 years ago psa was 13.55 3 months later it was only 13.8 which works out as a doubling time of about 6 years!! That would be fine. Clearly, that rate can change; the cells that survive RT must be the tough guys that can beat everything.....

The main concern is my age at 58. If I was 70+, I wouldn't be worrying so much; it has so long to get bad!!

But yes - there are many much worse off....

David

Edited by member 27 Feb 2018 at 11:22 | Reason: Not specified

User

Posted 27 Feb 2018 at 17:03

Originally Posted by: Online Community Member

Thanks Chris. Let us know about tomorrow.

So Lyn...John's went up to 0.1 then dropped below again? That's hopeful, surely? I know mine wavered between 0.03 and 0.05 for a year so why indeed shouldnt it drop from 0.1, as indeed John's did.

John's was rising on the ultrasensitive test before the hospital stopped offering it. It then went to 0.1, <0.1 0.11 and then has been <0.1 for a couple so it could be sitting at 0.08 or 0.099999 - it doesn't really matter. It went over 0.1 which is too high to be explained by adrenal activity or cycling or sex in a man with no prostate. He won't want to go on HT unless he is forced so we will keep on having the tests and see how long it is before it starts to rise properly, knowing that it might be years before he has to do anything about it.

The science says ultra-sensitive testing is unreliable at readings below 0.1 - a reading of 0.11 is therefore considered reliable because it is beyond the point of being detectable.

Ulsterman, the 20 sessions at higher dose was a trial being run at specific hospitals so perhaps your onco wasn't involved. She should be aware of the trail though as the findings so far are that fit men can take a dose of up to 3.2Gy without major problems, it is more effective that 37 fractions at 2Gy and has less side effects. John's was targeted at the prostate bed and bladder but not the higher lymph nodes.

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

User

Posted 27 Feb 2018 at 18:58

David it is too soon after RT to panic - yes your cells are still dying and you may have to wait another few months before you hit your nadir. John is nearly 6 years past SRT so it is rather different.

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

User

Posted 09 Mar 2018 at 13:10

Don't be devastated - look at my profile for John's results. He has gone up to 0.11 and then back to 0.1 and the last 2 results were <0.1 and we are a bit nervous but not devastated - the onco thinks that he may just settle there and bob around without ever having any more treatment, or it may rise again and at some point there will be a need for long term HT but since it is still hovering at 5.5 years post SRT if there is some cancer still lurking it certainly doesn't seem to be very active.

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

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User

Posted 11 Feb 2017 at 09:31

Thought I'd lost this thread but re-found it! Anyway, any knowledge most welcome, thanks!

David

User

Posted 11 Feb 2017 at 10:12

User

Posted 11 Feb 2017 at 11:36

Hi both read my profile.

So yes it can take a while to drop. In my case 2.5 years

Bri

User

Posted 11 Feb 2017 at 14:17

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

User

Posted 11 Feb 2017 at 14:23

I had 20 sessions of salvage RT in January 2016 when my PSA was 0.13 - over the past 12 months it has fallen to 0.06, 0.03 and latest result two weeks ago was less than 0.02 so undetectable.

Hope this helps reassure you that it takes a bit of time.

User

Posted 11 Feb 2017 at 18:18

Gosh I can't believe how helpful that has been- thanks guys!

OK, I know it could still be bad, but you have helped me a lot for now!

David

User

Posted 11 Feb 2017 at 18:35

Thanks for this thread David.

Thanks everyone 👍

Kevan

User

Posted 11 Feb 2017 at 21:17

Originally Posted by: Online Community Member

Gosh I can't believe how helpful that has been- thanks guys!

OK, I know it could still be bad, but you have helped me a lot for now!

David

Hi David,

If they are not already on the cards, I would push for diagnostics, PET/CT or PET/MR

Dave

Not "Why Me?" but "Why Not Me"?

User

Posted 11 Feb 2017 at 21:54

But Dave, such scans show nothing so low, I thought? Is the PET/MR you mention actually PET/MRI ?

User

Posted 11 Feb 2017 at 22:19

I suspect Crescent has misread where you are up to - no need for scans at this stage in your treatment unless you are on HT as well :-/

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

User

Posted 11 Feb 2017 at 23:14

Can't see any scans being offered on basis of current sort of level.

Barry

User

Posted 11 Feb 2017 at 23:14

What dictates whether you have 20 or thirty something sessions of SRT.

I also asked about a PSMA scan before SRT and was given the impression that RT would be given after a negative scan but withdrawn if the scan was positive.

Thanks Chris

User

Posted 11 Feb 2017 at 23:50

Whether or not your hospital is taking part in the research and/or whether your oncologist is aware of the trial outcomes, I guess, plus whether you are considered fit enough to take the higher dose?

They put John on the high dose regime because he was 52, still playing rugby, had been left with no continence issues post-op, etc. at that time, they were wanting to work out how high the dose can go before increased side effects start to outweigh the better outcomes in terms of remission. They seem to have settled at around 3Gy rather than the more traditional 2Gy although I seem to remember someone on here thinking they had been given 3.4Gy???

I suppose it would make sense not to offer salvage RT with a positive PSMA scan as remission is unlikely.

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

User

Posted 12 Feb 2017 at 00:01

Just an afterthought - when you got your latest result did you ask them to confirm that there wasn't a little 'less than' sign? I know we have mentioned this before in one of your threads but not all administrators and nurses understand the sign or its significance!!!!!

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

User

Posted 12 Feb 2017 at 09:25

Originally Posted by: Online Community Member

I suspect Crescent has misread where you are up to - no need for scans at this stage in your treatment unless you are on HT as well :-/

Yes, Lynn you are correct, I was really addressing the concern that David showed in a subsequent post regarding possible spread and taking another look at his numbers, a scan is probably a bit premature.

I hope David's PSA doesn't climb to that but it's worth keeping the scan option in mind if it does. No every onco seems to go for it, I had to press mine when my PSA was 0.6

Not "Why Me?" but "Why Not Me"?

User

Posted 12 Feb 2017 at 10:00

Hi, does it take 18 months to reach your lowest PSA after radiotherapy, not just salvage radiotherapy. 4 months after my OH finished radiotherapy the PSA is 1.3 , he is also on prostrap.

Sheila

User

Posted 12 Feb 2017 at 11:17

Hi Guys,

Perhaps I am thick, but one thing I have never properly understood is how much PSA a healthy man should have?

As I understood it PSA should be contained within the prostate, but as we get older and the prostate expands either through cancer or benign expansion the structure of the prostate gets a little distorted and PSA leaks out. I have thought of it like a car engine, when it is new all the oil stays inside, as it gets older, with worn bearings and gaskets some oil starts to leak?

So a man in his sixties, with no symptoms of PCa and a PSA level of 3 or even 4 is considered healthy? I wonder what PSA level is found in a healthy man in his 20's or 30's?

A decent size tumour will give quite a high PSA level, mine was 30 at diagnosis and the PCa was still contained within the gland, guys whose PCa has metastasised often have a PSA level in the hundreds.

So for men who have had RP, which has left some healthy prostate tissue at the margins are likely to have some PSA produced by those healthy cells. In the same way they go to a lot of trouble with EBRT to focus the beams on the cancer, and ditto with Brachytherapy they use the template biopsy to determine where to place the rods, they don't simply irradiate the entire prostate gland.

So whatever treatment we have had we should all be left with a few healthy bits and pieces of prostate that might be expected to produce some PSA.

So why do the doctors get concerned about such low levels of PSA?

Dave

User

Posted 12 Feb 2017 at 11:52

Dave, there should be no prostate tissue left after RP, healthy or otherwise, and the tiny amount of PSA still around is generated by the adrenal gland. Doctors will allow a higher 'healthy' PSA for a man that has had RT because he will have some remaining healthy prostate tissue which eventually will recover and regenerate. If RP leaves behind some prostste tissue the surgeon has failed.

A healthy young man in his 20s or 30s should have a PSA of less than 1 I think but you can google a table of 'normal'ranges at each decade.

Your statement about PSA in the tens or hundreds is a generalisation - we have men with PSA over 100 with no apparent cancer and then men like Si (PSA around 3 and multiple bone mets) and my father in law (died with a PSA of 1.2 - mets not spotted)

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

User

Posted 12 Feb 2017 at 11:55

Originally Posted by: Online Community Member

Hi, does it take 18 months to reach your lowest PSA after radiotherapy, not just salvage radiotherapy. 4 months after my OH finished radiotherapy the PSA is 1.3 , he is also on prostrap.

Sheila

Hi Sheila, slightly different when the man is on hormones as the HT keeps the PSA low. But the RT will continue to work to damage the cancerous cells for up to 18 months.

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

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