Psa raise 5 years after brachytherapy

User

Posted 20 Sep 2019 at 19:00

Hello. I just wondered what other people’s psa results were like 5 years on. Husband had brachytherapy almost 5 years ago. After 18 months psa went down to 0.01 where it stayed until 6 months ago it was 0.05 then this week it was 0.07 is this normal or should we be worried. It says online that there should be concern after 3 consecutive raises. Obviously only 2 at the moment. Any advice appreciated. Thanks.

User

Posted 09 Jan 2022 at 14:51

A belated Happy New Year to all The Guys & Gals who contribute their experiences and opinions on this Prostate Cancer UK Website.

I was diagnosed in 2009 T2NoMo Gleason 3+3(6) PSA 5.4 and enthusiastically opted for L.D.R. It took 3 years to reach my Nadir of 1.0 in March 2013 and has hovered around the 1.0 - 2.0 until very recently when in December 2021 my PSA reached 3.3. So, in summary as I approach my 13th anniversary after diagnosis, I am 2.3 above my Nadir and remain comforted by my Consultant Urologist who has never known a patient needing further treatment after the 10 year point. Of course I hope he is right and have agreed with him that perhaps a scan will be useful if and when the PSA is 5+. I will continue with PSA Blood Tests every 6 months or so and will play it by ear well by arm that is.

My Brachytherapy treatment has been an outstanding success and my encouragement goes out to everybody who is offered this treatment. Through the years I have painted my personal picture over and over again but offer it once more today. Since the procedure in April 2010 I have extensively traveled the world, ride my Mountain Bike 3 times every week and play Golf 3 times each week just returning home covered in mud which my wife does not thank me for.

I am 77 years of age and post this update as an encouragement not as a self promotion. I am the luckiest man in the world and shout from the roof tops for every man to get tested for Prostate Cancer.

Best wishes to all.

Chigwell 2010.

Edited by member 09 Jan 2022 at 15:42 | Reason: Not specified

User

Posted 24 Sep 2019 at 15:26

For newer members, here is sjtb's previous profile with history https://community.prostatecanceruk.org/default.aspx?g=profile&u=17880

and in the most recent 10 posts, a lot of the back story can be read.

sjtb, I would add this link to your new profile and / or copy from your old profile into your new one?

In the context, I think it is super news that his PSA is still 0.07 👍

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

User

Posted 24 Sep 2019 at 15:42

Some people get readings like 0.07 as in the previous post.

All I got from my assigned cancer care nurse in July was that My PSA was less than 0.1 which means undetectable.

User

Posted 27 Jun 2020 at 17:29

Thanks for reply Barry. Yes I guess we’ve done all we can. I think the pain he’s getting is worrying him more than the psa raise really. So now we just await an appointment with urologist. GP hasn’t referred him to oncology he will leave that to the urologist.

I suggested he ask the surgery for a print out of all previous psa readings, he said no, there will be a fee for that. He thinks the GP will put all the readings in the letter to urologist.

Show Most Thanked Posts

User

Posted 20 Sep 2019 at 20:04

He still has a prostate so the PSA is expected to rise as healthy cells regenerate. As long as it stays below 2.0 all is well.

The thing about 3 successive rises applies to men that have had surgery.

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

User

Posted 20 Sep 2019 at 20:20

Ok thanks very much Lyn.

User

Posted 21 Sep 2019 at 07:16

There doesn’t seem to be much on the internet about psa after radiotherapy. All I can find is that once it reaches nadir after 18 months to 2 years, it should remain there. Even on this site it says if it raises 3 times in a row (after brachy or RT) then it may be recurring. I guess all we can do is wait another 6 months for the next test.

Edited by member 21 Sep 2019 at 07:17 | Reason: Not specified

User

Posted 21 Sep 2019 at 23:01

No - it is not expected to stay at nadir for evermore. The point of biochemical recurrence is nadir + 2

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

User

Posted 23 Sep 2019 at 19:29

Mine started rising after about five years , got to 3.1 had scan , had three tumours ,

Please see my Bio

regards Barry

User

Posted 23 Sep 2019 at 20:33

Thanks Barry. We don’t know what to think really. I guess it’s wait 6 months for next psa. As Lyn says he could just be producing more psa as the prostate is still there. But I know a few people that have had brachytherapy and theirs isn’t rising. It is raising very slowly anyway. 0.01 to 0.05 after 6 months then up 0.07 6 months later. So up .06 in a year.

User

Posted 23 Sep 2019 at 21:08

It would help to put the timeline with PSA values and treatment dates in your bio.

The other thing that's important on the timeline is when he finished taking hormone therapy.

Also, I presume we're talking about seed brachy here, not HDR brachy?

User

Posted 23 Sep 2019 at 21:25

Thanks. I did write all details originally. Then I couldn’t sign in on my old account. So I created a new user name that I am now using. I can’t remember if I put any details in under this name. I had everything written with dates, it’s annoying I can’t sign back into that account

Yes seed brachytherapy. He didn’t have any hormone therapy. He was told it wasn’t needed. We know 3 people that had brachytherapy with the same consultant. None had hormone therapy. We were told hormone therapy shrinks the prostate down ready for treatment. But as the prostate was of normal size they said it wasn’t necessary. I have heard from others on here on my original thread that that isn’t correct.
But at that time we just did as recommended.

User

Posted 23 Sep 2019 at 21:35

I just contacted the help page to ask if I can get my old account back (when I sign in it says wrong email address but I’ve always had the same email) all the info is on there. I went by the name of sjtb if anyone wants to read bio. Thanks.

User

Posted 24 Sep 2019 at 07:44

A Quick Point

My PSA slowly started to rise , over two years after my 37 sessions of RT

and three years on Prostap

I had a PET/CT scan when I hit 3.1

it showed three small tumours ,

I seen an Onco privately after I was advised by another member on here

I asked could I have six sessions of Docetaxel Chemo as well as going back

on Prostap , I have now been 0.04 for almost two years now and they are going to

put me on intermittent therapy if my next PSA test comes back 0.04

I am so glad for the member on here who contacted me

I was TB3 with a Gleason score of 4+4

User

Posted 24 Sep 2019 at 15:26

For newer members, here is sjtb's previous profile with history https://community.prostatecanceruk.org/default.aspx?g=profile&u=17880

and in the most recent 10 posts, a lot of the back story can be read.

sjtb, I would add this link to your new profile and / or copy from your old profile into your new one?

In the context, I think it is super news that his PSA is still 0.07 👍

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

User

Posted 24 Sep 2019 at 15:42

Some people get readings like 0.07 as in the previous post.

All I got from my assigned cancer care nurse in July was that My PSA was less than 0.1 which means undetectable.

User

Posted 12 Mar 2020 at 11:09

Latest psa is 0.09 so that’s the 4th rise in a row, everyone else I’ve spoken to that has had brachytherapy psa has remained at the lowest level. DH’s lowest was 0.01 where it remained for several years

Not sure what to make of it. But it is still very low. If we have to wait until it gets up to 2 before they find out what the problem is, if it raises at the same rate, it will take a few years to get to 2. So far 2 years to go from 0.01 to 0.09

User

Posted 26 Jun 2020 at 17:13

Ok. So latest psa is 1.1 if it was 0.01 then 0.05 then 0.07 then 0.09 shouldn’t it go 0.10 or 0.12 etc next? If so up to 1.1 from 0.09 in 3 months is quite a sudden jump.

That’s a bit worrying. He’s been referred to the urologist anyway as he’s been getting pain in the prostate area for a long time.

User

Posted 26 Jun 2020 at 18:08

Hi, I haven't read your full profile but it is surprising that his psa was 0.01 after brachytherapy. That treatment doesn't remove the prostate so I would have thought it normal to have a psa of less than 1 perhaps.

I just did a quick search and it says 0.6 to 1.4 would be normal. Others will comment I'm sure but are you sure you haven't got decimal places mixed.

Regards Peter

User

Posted 26 Jun 2020 at 18:48

Thanks for reply. Yes it was 0.01 for several years. Taken twice a year. To start with taken at the hospital then twice yearly with the gp.
4th rise in a row now. I’m sure that can’t be normal. I only know of 4 others that have had brachy. 3 of them remain very low. The other is up at almost 3 and awaiting scans etc.

User

Posted 26 Jun 2020 at 18:51

Meant to say....No not got the decimal wrong as I’ve seen a print out from one report back when it was 0.01 as he had other blood tests too. But I did wonder if my husband had the decimal wrong this time. I asked if he meant 0.11 which would still be up but only by a little. He said no definitely 1.1

User

Posted 26 Jun 2020 at 20:41

It is odd that his PSA went down so low - in the 18 months after his brachytherapy, his PSA readings were 0.78, 0.76 and then 0.7 so a PSA of 1.1 would seem well within expected range. Whatever happened in the time between 2017 and now, a PSA of 1.1 is okay for a man who still has a prostate - if it goes over 2.0 in the future the onco might be a little bit concerned.

As I said above, the '3 successive rises' thing relates to men that have had their prostate removed. Your husband's PSA is expected to rise because healthy prostate cells are regenerating.

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

User

Posted 26 Jun 2020 at 21:04

Thanks for reply Lyn. It was at 0.01 for at least 4 readings taken twice a year. It does say on this site (I think, but may have read somewhere else) that after brachytherapy 3 rises in a row should mean a return to a consultant. I think we got a 0.02 first but didn’t think much of it. Then 0.05 so that is actually 5 rises now. But as he is getting quite a lot of pain in that area (enough to keep him awake) maybe it could be something else. The gp always says it’s prostatitis so he’s been on antibiotics for a couple of months now. I’d like to hope it can’t be prostate cancer returning as that surely it wouldn’t hurt. Is that a symptom? Maybe in advanced stages but hopefully not this early on.

The gp is writing to ask for a quick referral with the urologist. But with the current situation I don’t suppose it will be quick. I’m thinking I probably won’t be able to go with him this time either. He never seems to listen to what has been said.

User

Posted 26 Jun 2020 at 22:36

I think it would be worth you asking for a full print out of the PSA history as it just doesn't make any sense to go from 0.7 in Spring 2017 to 0.01 at the next test and men simply don't see a PSA of 0.01 after brachy unless they are on hormone treatment. If the decimal point has got a bit muddled and the readings went 0.78, 0.76, 0.7, 0.1, 0.1, 0.1, 0.5, 0.7, 0.9, 1.1 that would be a classic trend post-brachy.

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

User

Posted 27 Jun 2020 at 06:20

My husband usually just phones up for psa results. Like yesterday. Then writes it down. He’s got it all in a book. Then he has to phone it through to the consultant at the hospital. Though last time there was a recorded message saying the consultant or his secretary were not available for the foreseeable future. I am assuming due to Covid so obviously no message left

On one occasion he had a print out because he had cholesterol etc. taken at the same time. I read the print out too. It definitely said 0.01 I will look at his written down figures.

I have suggested he call again with the new results as he may be back now. Hopefully the consultant will pick up on it raising. Though he did say he’d only see him back if it gets up to 2.

That is a good idea to ask for a print out. Thanks. He Can show the urologist then.

User

Posted 27 Jun 2020 at 15:20

Increasing PSA could be due to some regeneration of cells in the Prostate which is quite usual with a previously radiated Prostate or could be a new tumour. If the latter, the chances are small at present of it being found in a scan with a PSA so low. I would not be surprised if consultant wants another PSA test to check whether the last one was a spike for some reason or showing an accelerated upward trend, perhaps in 3 months or sooner. However, we know that consultants can differ in the way they react to PSA results, some seemingly being more proactive in instigating more tests/treatment than others. You have done what you can and I don't think can do more for the time being pending. I think it will be more for an oncologist to take forward if PSA continues move upwards more steeply.

Barry

User

Posted 27 Jun 2020 at 17:29

I suggested he ask the surgery for a print out of all previous psa readings, he said no, there will be a fee for that. He thinks the GP will put all the readings in the letter to urologist.

User

Posted 27 Jun 2020 at 17:48

Hi I had low dose Brachytherapy in September 2016 and it has only just reached 0.18 after 45 months with twelve monthly Psa tests.

Oncology seem happy with my results so far and i feel i have been very lucky with little or no side affects so far.

John .

User

Posted 27 Jun 2020 at 20:00

Originally Posted by: Online Community Member

I suggested he ask the surgery for a print out of all previous psa readings, he said no, there will be a fee for that.

You GP is not permitted to charge you for access to your patient records. The access has to be free.

User

Posted 27 Jun 2020 at 20:33

Thanks Andy. But if someone has to go through 6 years worth of psa and type it out I’m sure they won’t do it without a charge. It’s a bit different to actually accessing your records. I’m sure there probably is another way to access them.

User

Posted 03 Jul 2020 at 16:35

I have had RT, Brachy and Zoladex.

A year after finishing Zoladex, my PSA has risen from 0.1 to 0.18 and now to 0.22.

The Registrar discussed with the Oncologist and they have said no need for further tests until, or if, it reaches 2.0.

User

Posted 05 Jul 2020 at 18:26

You are entitled to all your medical records free of charge , I got mine which I found every interesting what you could understand , but the basics there history of the 20 fractions , history of psa tests etc , thank you Nhs I didn’t realise so many professionals involved in the treatment process !

User

Posted 05 Jul 2020 at 18:28

Originally Posted by: Online Community Member

I have had RT, Brachy and Zoladex.

A year after finishing Zoladex, my PSA has risen from 0.1 to 0.18 and now to 0.22.

The Registrar discussed with the Oncologist and they have said no need for further tests until, or if, it reaches 2.0.

all correct procedures AlanM

User

Posted 05 Jul 2020 at 18:31

Thanks.

I should think it would be a book the amount of times my husband has been to see the gp 😉

User

Posted 06 Jul 2020 at 00:47

Originally Posted by: Online Community Member

I have had RT, Brachy and Zoladex.

A year after finishing Zoladex, my PSA has risen from 0.1 to 0.18 and now to 0.22.

The Registrar discussed with the Oncologist and they have said no need for further tests until, or if, it reaches 2.0.

AlanM,

Raise in PSA is entirely expected as your testosterone level recovers. You still have a prostate, and it still has working cells, which will switch back on and start generating PSA.

It is useful to get your testosterone measured too when you come off hormone therapy, until it's back to normal. Without knowing where you are along testosterone recovery path, the PSA reading isn't very useful.

User

Posted 06 Jul 2020 at 00:51

Originally Posted by: Online Community Member

They're not permitted to charge. They probably won't go through 6 years worth of psa and type it out, they'll just print (or photocopy) everything, and you have to search it.

In the case of my GP, they gave me online access, and I went through about 10 years, making sure I had everything (I was missing a few blood test results, which I found in there).

User

Posted 07 Jul 2020 at 11:37

They shouldn't have to go through records at all, they should be on the NHS system, so it's a case of printing out a time frame to get them all. They aren't allowed to charge for access to your records.

I had HDR brachy and EBRT, my PSA afterwards was all over the place for first 3 years but finally settled to <0.1 for the last 2 years. When mine kept climbing and they got concerned as it went near to 2.0, but thankfully still <0.1 at last weeks blood test. They said there could be some bounce as prostate still present and sort of working as already pointed out in a previous post, so that my be what is happening.

Good luck and best wishes in these difficult times.

Mike

Edited by member 07 Jul 2020 at 11:38 | Reason: Not specified

User

Posted 08 Dec 2021 at 22:28

I thought I’d just update to say psa is still rising. Only slowly. But each 6 monthly test it goes up for the last 8 years. In a post above I said it had jumped from 0.7 to 1.1 but after asking dh to get a printout it was 0.17. I thought he might have missed a zero. But we are now ay 0.9 (0.3 6 months ago)

I am assuming the cancer is returning. But I don’t think they will see him until the psa is at 2. So maybe in about a year. DH’s daughter has just found out she has the BRCA2 gene. We are assuming it’s coming from DH he’s had blood tests but will be a while until we find out.

User

Posted 08 Dec 2021 at 22:43

As per my previous replies to you - 0.9 is a great PSA result, your husband still has a prostate. Absolutely no reason to think the cancer has come back!

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

User

Posted 08 Dec 2021 at 22:48

Hmm. Thanks Lyn. However I’m not convinced. Too many rises. At the speed it is going up it’ll be 2 this time next year. On our printout it’s gone from 0.01 to 0.9 in 4 years. I’ll let you know in a years time.

User

Posted 09 Dec 2021 at 00:24

You are probably over-worrying - 0.01 to 0.9 is perfectly reasonable as healthy prostate tissue will have recovered after the brachy and will continue to do so. The rise in PSA usually correlates with the recovery of testosterone.

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

User

Posted 09 Dec 2021 at 07:51

Thanks Lyn. He didn’t take hormones. So i don’t know whether brachytherapy alone makes any difference to testosterone levels.

The other thing is the fact we know several others that have had the same treatment, plus a couple on here who had private messaged me at the time, all but one have had the psa remain at the low, not increase, the only one who’s has increased is now at 4 and seeking treatment.

I’ll let you all know in a years time. I do often look on here and have a read. But don’t comment.

Edited by member 09 Dec 2021 at 08:02 | Reason: Added something else.

User

Posted 07 Jan 2022 at 13:26

PSMA-PET can be seen as a miracle device. In fact it is incredibly useful but not in all cases. I would have thought yours was a textbook case for it. So if it were my prostate I would be asking for it. I hear the vastly-knowledgeable LynEyre and it is probably benign, but I hear you too and I can see why you think something is off. Given the stakes, for my prostate, I would want more than "probably". A scan would not be definitive but if it did find something you'd be in a great position compared to waiting. The trouble is all these criteria: 0.2 for surgery, nadir+2 for RT, are out of date in the modern imaging world. Imaging is a huge, huge change and these Drs need to adjust accordingly: it might not work but I'd be pushing them. Just my 2¢.

User

Posted 07 Jan 2022 at 14:13

Thanks. I don’t suppose anything will be offered for a while. DH has seen a letter written from the consultant to his gp saying that he must refer dh as matter of urgency as soon as psa reaches 2.1. Not sure how long that will be. But I’m fairly sure it is going to reach that at some point. It has taken 3 years to get from 0.01 up to 0.9. Though jumped the most in the last year. We will have to wait for the next psa has a test every 6 months.

User

Posted 07 Jan 2022 at 14:20

Originally Posted by: Online Community Member

The trouble is all these criteria: 0.2 for surgery, nadir 2 for RT, are out of date in the modern imaging world. Imaging is a huge, huge change and these Drs need to adjust accordingly

SUM, why do you think the threshold criteria are related to imaging? The BCR thresholds are based on what amount of PSA can be generated in a body that doesn't have prostate cancer - I don't think there is any relation to imaging.

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

User

Posted 08 Jan 2022 at 19:33

My PSA about a month ago was < 0.01 at least thats what the lab reported, they must have some very sensitive equipment!

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23 <0.01

User

Posted 08 Jan 2022 at 19:47

That’s good isn’t it. DH’s went to 0.01 too. Stayed there a few years.

User

Posted 08 Jan 2022 at 23:06

@LynEyre : "SUM, why do you think the threshold criteria are related to imaging? ". That's the point - they aren't, and they should be. Let's leave surgery out of it because 0.2 is still usually below PSMA-PET sensitivity. But for RT guys, 2 is roughly 7x and is historic and arbitrary. I've been slow to reply because I can't think of a great analogy. But let's say you're worried your kitchen is on fire and you can only tell if that's happening when the paint on the door peels. If you invent a window through the door, do you wait till the paint peels before you look through the window?

User

Posted 09 Jan 2022 at 01:00

No, I think you have missed the point. You want someone to look through the window and xall the fire brigade every time I light a candle.

If a man has had EBRT, brachy, FLA, HIFU or whatever and his PSA reaches 2, there is no reason to be concerned. If it goes over 2+nadir, he is in BCR regardless of what scans might or might not be arranged or what they might show. Some oncos don't arrange a new scan or restart treatment until the PSA reaches 5, 10 or even 20 - he was still in BCR as soon as he hit that 2+nadir threshold.

You perhaps have an unrealistic confidence in the reliability of scans. CJ had BCR and the best tracers available but his PSA reached 100 and still nothing was showing up on the scans. Some PCa just doesn't show up and micromets are almost impossible to detect until it is too late.

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

User

Posted 09 Jan 2022 at 07:45

Yes I get that and there is even an argument for “ignorance is bliss”. But let’s just say 2 predates imaging and can be high in some circumstances. Going back to our poster as a decent example, I personally would be pushing for a scan.

User

Posted 09 Jan 2022 at 14:51

A belated Happy New Year to all The Guys & Gals who contribute their experiences and opinions on this Prostate Cancer UK Website.

I am 77 years of age and post this update as an encouragement not as a self promotion. I am the luckiest man in the world and shout from the roof tops for every man to get tested for Prostate Cancer.

Best wishes to all.

Chigwell 2010.

Edited by member 09 Jan 2022 at 15:42 | Reason: Not specified

User

Posted 09 Jan 2022 at 17:08

Good to see you popping in Chigwell and thrilled to see that you a) have managed to survive the pandemic and b) are still riding that mountain bike

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

User

Posted 09 Jan 2022 at 17:49

Chigwell. Great to hear you are doing so well. Those we know that have had brachy and the cancer has returned have had it return a while before the 10 year mark. So that is probably correct about reaching 10 years. DH had his 7 years ago, almost exactly as he had it in the January just after his 58th birthday. He will be 65 later this month.

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Psa raise 5 years after brachytherapy

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