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User
Posted 11 Sep 2017 at 12:44

I had radiotherapy for Prostate cancer 13 years ago  (I am now 68) and all has been well with PSA levels down to almost zero. I even forgot to have my PSA checked last year, it just never entered my mind. I had a blood test a couple of weeks ago for something else and asked them to do a PSA one too, which they did.  The result showed an increase from near zero to 4.7. I have no infection that i know of or any other pains. Anyone able to advise on what is happening? 

User
Posted 18 Sep 2017 at 11:39

Thank you for that info Dave and Andrew. It was quite a shock as it had all gone out of my mind and didn't even have a PSA test last year. My readings were less than .1 five yrs ago but not bothered to check since. Just found out today that in 2015 it had doubled to 1.49. I was not informed of this!
Urine infection has been ruled out. So being referred to the local hospital in the normal 2 weeks.
Interested to hear about your experience Dave.

User
Posted 20 Jun 2023 at 08:23

Originally Posted by: Online Community Member
If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy doesn't work that way.

Radiotherapy exploits a property of cancer cells that makes them much more vulnerable to radiotherapy damage than healthy cells are. The radiotherapy deliberately damages cells' DNA. Healthy cells can repair their DNA when it gets corrupted (which happens regularly in normal life), whereas a cancer cell became a cancer cell because it lost its ability to repair DNA corruptions, and picked up a set of DNA corruptions which made it malignant (dividing and multiplying uncontrollably). Radiotherapy generates enough additional DNA corruption to stop the cancer cells being able to divide and multiply, while the healthy cells can repair the DNA corruptions induced by radiotherapy. There is collateral damage to healthy cells too, and that is what generates side effects. The radiation dose is set at a level where the collateral damage doesn't risk killing the organ, because a necrotic organ the size and position of the prostate would be fatal. (I vaguely recall this is around 10% collateral damage, but I might be wrong here.) The organ must remain viable such that it can maintain itself, fight infections, etc. So after the radiotherapy, the cancer cells are no longer malignant and will simply die of old age over the next 18-36 months, plus a small percentage of healthy cells are similarly destroyed. The prostate is capable of regenerating tissue, and as the impacted cells die off, it may form new replacement tissue. A second effect of the repeated damage and healing cycles of radiotherapy is that fibrous tissue forms during the healing. The prostate is a muscular organ, and this stops it from being able to contract and expel its contents as it normally would.

On average, prostates are about 5% effective after radiotherapy, but this is heavily skewed to most not working at all, and a small number still up to 50% effective. This can depend on the extent of the cancer in the prostate at treatment time.

Radiotherapy doesn't make the organ vanish.

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User
Posted 11 Sep 2017 at 14:08

Hello Davee

I can't be of much help with your question but I'm sure that others will advise you.

You say you have no infection that you know of but is that based on how you feel as I assume that the GP has checked you for infection

Has your GP referred you back to the hospital?

We can't control the winds - but we can adjust our sails
User
Posted 11 Sep 2017 at 16:48
I would suggest that you see your g.p and ask that he/she refer you back to the hospital for further tests and checks. Good luck
User
Posted 14 Sep 2017 at 10:38

Hi Davee,

As others have pointed out, one test alone doesn't prove anything, I guess further tests/scans etc may be needed.

I see like me you had radiotherapy some years ago, I guess you were told at the time that you could only ever have one bout of radiotherapy.  If it worked it worked, if not then it was hormone therapy for the rest of your life?

That has changed, if you check my profile there are all the details of salvage HDR brachytherapy.  'Fingers crossed' it is working for me, and even if it is not it is buying me a lot of time with my PSA bumping along at currently a mere 0.5

So hopefully you don't have a reoccurrence, but if you do please be aware that science has moved on and new treatments are available.

:)

Dave

User
Posted 18 Sep 2017 at 11:39

Thank you for that info Dave and Andrew. It was quite a shock as it had all gone out of my mind and didn't even have a PSA test last year. My readings were less than .1 five yrs ago but not bothered to check since. Just found out today that in 2015 it had doubled to 1.49. I was not informed of this!
Urine infection has been ruled out. So being referred to the local hospital in the normal 2 weeks.
Interested to hear about your experience Dave.

User
Posted 19 Sep 2017 at 09:48

Hello yes urine tests were neg. Referred to local hospital in next 2 weeks.

User
Posted 26 Oct 2017 at 11:43

Latest blood test is down to 4.3 from 4.7 ?? Urologist examined my prostate and commented that it was small He is deciding what to do. I have no symptoms at all. I have had bad Gout for last 2 years dont know if that can be connected?

User
Posted 26 Oct 2017 at 14:24

That's interesting Andrew. I have having Allopurinol for gout at 300mg rather than earlier 100mg daily for long before being diagnosed with PCa, so haven't checked the info literature that comes with it which presumably mentions this. Although my treating consultants should have been aware of this from my records, none of them mentioned it as a potential source for increasing PSA.

Barry
User
Posted 30 Oct 2017 at 11:57

I was told their decision re what they intend to do. They consider the PSA reading which is now 4.3 does not justify any immediate action. They have suggested if it reaches 10 then they will do a MRI scan. Im not happy about this as I shouldn't have a significant reading at all after having had Radical RT. It also appears the committee were not told I had had RT. :-(

User
Posted 30 Oct 2017 at 15:19

Davee, RT doesn't destroy the prostate, so you should still have a positive reading, close to normal, say 4 I reckon the advice you have been given is sound, subject to resolving the issue about your medication.

AC

User
Posted 30 Oct 2017 at 15:23

Hi Davee

 

You mentioned you had a "Radical RT".....do you mean RP (radical prostatectomy)?

If you still have your prostate...then some PSA will still be detected and produced.

IF you had an RP...then I think ANY PSA would indicate Mets.

BC

Edited by member 30 Oct 2017 at 15:25  | Reason: Not specified

User
Posted 30 Oct 2017 at 20:02

Bill, Daveee had radical RT - radical simply means that it was the primary treatment.

Davee, your prostate will have recovered somewhat and the healthy prostate cells will be generating PSA. The level has gone high enough to be concerned but you can't have any more RT so what would you want the doctors to offer you as a treatment? Hormone therapy would be long term now and does not last forever so perhaps the MDT are trying to delay starting HT for as long as they can? Have they said how high your PSA needs to go before they put you back on treatment?

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

User
Posted 29 Nov 2019 at 13:19
Helllo, Im sorry I have not been on for a while. My PSA has been up and down the last 2 years and was at 7.24 in October 2019, (7,28 in October 2018). Just to confirm I had radiotherapy in 2004 when my PSA was 15. (Gleeson 5, T2 2 +3). The hospital say i should start Hormone treatment at PSA 10. However at 70 yrs of age and readings being so slow moving im hoping it wont be necessary.
User
Posted 11 Apr 2021 at 21:02
Mt PSA readings since I was told my pc had come back after 13 years.

Sep 2017 4.76

Oct 2017 4.37

Jan 2018 5.35

Apr 2018 5.90

July 2018 5.99

Oct 2018 7.28

Jan 2019 5.75

Apr 2019 6.31

Jul 2019 7.14

Oct 2019 7.24

Jan 2020 6.93

Jul 2020 7,53

Oct2020 6.26

Jan2021 7.13

User
Posted 12 Apr 2021 at 04:47
On the basis of your PSA record, it could still be 2 or 3 years or even longer before it reaches the arbitrary 10 figure given by your consultant. Your Jan 2021 figure is lower than the one in Oct 2018 so PSA is not 'taking off'. However, PSA figurers alone cannot be relied on completely. In your situation I would ask whether you could have a mpMRI to check on what might be happening. If thought advisable it might be suggested you then have a Biopsy and perhaps some focal therapy. This is what I had in 2015 when my PSA was lower than yours as HIFU as salvage treatment for failed RT. It did knock back the PSA but this has now increased and I am due to learn the result of my latest mpMRI this month. It's possible that I may be offered repeat HIFU, told I can start HT or wait another year for a further mpMRI or unusually high PSA figure. I have previously rejected further HT due the side effects I had with it in 2008 when I had it with my RT.

i

Barry
User
Posted 19 Jun 2023 at 09:13
Well 2 years on amd most of that time burying my head in the sand my March PSA reading was 12.48. I had a meeting with my urologist and they said I should start Hormone treatment straight away (Bicalutamide 50mg plus injections).

This was a tough decision. I declined the offer! My reasons were -1) My CT scan was clear, 2) I feel great and am very active with no aches or pains and did not want to suffer the side effects of treatment until I have to!

I had another PSA blood test 3 weeks ago and my reading had gone down over 25% to 9.1!

(This coincided with me mirroring a successful trial involving Oxford University a few years ago where 68% of 100 men saw a reduction in their PSA readings. I simply took pomegranate, green tea, broccoli and turmeric capsules each day during the 3 months).

I really dont understand what is happening or if I made the right decision, I would like your opinions.

User
Posted 19 Jun 2023 at 09:46

I honestly do not know what I'd do in your position - and that could happen any time, of course!

I really don't want to 'rain on your parade', and I hope the lack of any sign & symptoms mean that your choice was correct, but two things concern me:

1. I'm not sure that CT was the best scan to have, looking for possibly very small metastases.

2. Assuming for a moment that there ARE metastases, lowering your PSA is not the same as making any difference to the cancer itself. The Oxford study indeed demonstrated "a significant short-term effect on PSA and is food for thought for men living with prostate cancer", however it did not demonstrate any longer term effect (positive or negative) on the cancer itself. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020278/

The thought of going back on hormones, indefinitely, is not a cheerful thought, and I can see the attraction of going on to 'watchful waiting'. But there is a little bit of a gamble there, even though things seem to be moving very slowly, if at all.

So it seems to be a matter of keep taking the polyphenol-rich whole food supplements, keep in touch with the GP, and - as we all do - keep your fingers crossed?

Edited by member 19 Jun 2023 at 09:49  | Reason: readability

User
Posted 19 Jun 2023 at 20:57
As you still have a prostate I assume they have ruled out an infection?

A 25% PSA reduction seems unusual if it's cancer..

User
Posted 19 Jun 2023 at 21:29
I know nothing about the science of the Uni trial but do the supplements simply reduce the PSA rather than affecting the source of the PSA?

On it's own PSA does no harm to the body - it's a marker for cancer cells so simply reducing PSA maybe does not impact what creates it in the first place?

Just a thought and I'm no expert or scientist.

User
Posted 19 Jun 2023 at 22:01

If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy sure ain't surgery, but if done right, the effects are much the same.

(I certainly hope so, having had it myself!)

User
Posted 19 Jun 2023 at 22:59

Originally Posted by: Online Community Member

If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy sure ain't surgery, but if done right, the effects are much the same.

(I certainly hope so, having had it myself!)

That's not quite right - healthy cells left behind after RT can regenerate and will produce some PSA which is why biochemical recurrence is defined as 2.0 + nadir 

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

User
Posted 19 Jun 2023 at 23:24

A small number of cells, but that does not a prostate make. The 'ideal' post Radiotherapy PSA approaches zero.

As I said, if it's done its job: it isn't perfect, but it generally does a pretty good job.

User
Posted 20 Jun 2023 at 01:24

Originally Posted by: Online Community Member
This was a tough decision. I declined the offer!

Yes, in the same position I'd go the same way and try to avoid HT. Old Barry's suggested path in its pursuit of further treatment obviously requires some persistence with the medical system and he's set a good example of fighting on. Sometimes I think doctors take the easy option with older patients when life expectancy rears its head as a factor.

Jules

User
Posted 20 Jun 2023 at 05:52

Originally Posted by: Online Community Member

A small number of cells, but that does not a prostate make. The 'ideal' post Radiotherapy PSA approaches zero.

As I said, if it's done its job: it isn't perfect, but it generally does a pretty good job.

After Prostatectomy you have no actual Prostate whereas after radiation to the Prostate you do, even if it's a bit sticky with scar tissue, so quite different after the two procedures.  Have seen many scans post RT (including my own), some with no cancer and some with and biopsy can still be done.  Some seven years after RT, I had a very extensive multi core  template biopsy which showed only one core to have cancer.  This they were able to see and reach with HIFU. 

Incidentally, some cancer cells can be radio resistant and with a Prostate, even a radiated one, there is the potential for a new tumour to start, as well as normal cells to regenerate.. 

Barry
User
Posted 20 Jun 2023 at 08:23

Originally Posted by: Online Community Member
If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy doesn't work that way.

Radiotherapy exploits a property of cancer cells that makes them much more vulnerable to radiotherapy damage than healthy cells are. The radiotherapy deliberately damages cells' DNA. Healthy cells can repair their DNA when it gets corrupted (which happens regularly in normal life), whereas a cancer cell became a cancer cell because it lost its ability to repair DNA corruptions, and picked up a set of DNA corruptions which made it malignant (dividing and multiplying uncontrollably). Radiotherapy generates enough additional DNA corruption to stop the cancer cells being able to divide and multiply, while the healthy cells can repair the DNA corruptions induced by radiotherapy. There is collateral damage to healthy cells too, and that is what generates side effects. The radiation dose is set at a level where the collateral damage doesn't risk killing the organ, because a necrotic organ the size and position of the prostate would be fatal. (I vaguely recall this is around 10% collateral damage, but I might be wrong here.) The organ must remain viable such that it can maintain itself, fight infections, etc. So after the radiotherapy, the cancer cells are no longer malignant and will simply die of old age over the next 18-36 months, plus a small percentage of healthy cells are similarly destroyed. The prostate is capable of regenerating tissue, and as the impacted cells die off, it may form new replacement tissue. A second effect of the repeated damage and healing cycles of radiotherapy is that fibrous tissue forms during the healing. The prostate is a muscular organ, and this stops it from being able to contract and expel its contents as it normally would.

On average, prostates are about 5% effective after radiotherapy, but this is heavily skewed to most not working at all, and a small number still up to 50% effective. This can depend on the extent of the cancer in the prostate at treatment time.

Radiotherapy doesn't make the organ vanish.

 
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