Interpreting PSA Results

User

Posted 22 Oct 2021 at 19:08

A year ago my Prostate Specific Antigen (PSA) Level was shown to be 25 ng/mL and I subsequently embarked on a course or Radiotherapy (20 sessions April/May) and Hormone Therapy (still on). My latest Blood Test results show PSA is now at 1.9 ng/mL.

Getting PSA down from 25 to 1.9 is obviously good news, though I would have expected it to be 0.1 or something nearer this given that I am on Hormone Therapy!

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

User

Posted 22 Oct 2021 at 21:47

Hi John, that does sound quite high post RT/HT.... I was at 0.11 prior to my RT, which I have recently completed (after circa 9 months on HT), and will be having my next PSA test mid November where I would hope it would be a fair bit lower again. Have you had any comment on the PSA result from oncology yet ? Have you had other PSA tests post your RT as it was a while ago now ?
Cheers,
Nick

Edited by member 22 Oct 2021 at 21:52 | Reason: Additional info

User

Posted 22 Oct 2021 at 22:18

There isn't a good or bad PSA in your situation John; some people drop to below 0.1 while others stay around the 2 mark. The RT will carry on doing its stuff for about 18 months - that is when you are expected to hit your nadir (lowest PSA reading). You also started at quite a high reading and different HTs bring the PSA down to different levels. If your PSA rises over the next couple of tests, the onco will be more concerned but if it drops or stays where it is, I don't think you should worry yet.

When was your most recent decapeptyl depot - September? If you are worried, ask the GP practice to do a testosterone check with your next PSA - it should be at 0.69 or below.

Edited by member 22 Oct 2021 at 22:21 | Reason: Not specified

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

User

Posted 22 Oct 2021 at 22:30

Originally Posted by: Online Community Member

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

Hi John, have also had the same concern as my lowest reading on HT has been 1.49. Seems to hover between 1.5 and 2. Onco seems unconcerned as I still have a prostate so will still have PSA. Seems strange when some posters, as you point out, have seriously lower readings.

Steve

Good luck to everyone coping with the insidious big C

User

Posted 23 Oct 2021 at 00:20

Some oncos don't like their patient to have a PSA test until at least 6 months after the final RT session. John had 3 monthly tests. I think because you are a bit concerned, another test in December would be a reasonable thing to ask for.

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

User

Posted 24 Oct 2021 at 15:25

https://community.prostatecanceruk.org/posts/t23233-Brachytherapy---Radiation-buildup

I posted on this thread a while back. I hope it explains the 18 month delay.

Edited by member 25 Oct 2021 at 16:59 | Reason: Not specified

Dave

User

Posted 24 Oct 2021 at 16:15

Originally Posted by: Online Community Member

Thank you - but in what sense does it act over 18 months? i had imagined that the RT would attack the cancer cells and kill them off at the time of the fraction or shortly after. I am also imagining that with RT killing off cancer cells this reduces "supply" to the mets that will also be hit by the non-existence of testosterone and that is why the onco said no treatment, at this stage, of the mets. I would have preferred to zap the lot at the same time.

The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all. The cells don't die when they are zapped; the RT just damages their DNA so that they can't replicate.

I think that your imagining of what happens during RT is not how it really is. It isn't possible to lie on the bed while a machine zaps your prostate and then gives a couple of bones a quick shot as well. The onco takes measurements of exactly where the tumour is and then writes a computer programme specifying how much dose each tiny wave is to deliver and how deep - the programme can't deliver to two different destinations at the same time. The HT should be starving the mets.

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

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User

Posted 22 Oct 2021 at 21:47

Edited by member 22 Oct 2021 at 21:52 | Reason: Additional info

User

Posted 22 Oct 2021 at 22:18

When was your most recent decapeptyl depot - September? If you are worried, ask the GP practice to do a testosterone check with your next PSA - it should be at 0.69 or below.

Edited by member 22 Oct 2021 at 22:21 | Reason: Not specified

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

User

Posted 22 Oct 2021 at 22:30

Originally Posted by: Online Community Member

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

Steve

Good luck to everyone coping with the insidious big C

User

Posted 22 Oct 2021 at 22:54

Thanks for all the feedback and advice, much appreciated. Picking up on questions in previous posts .....

This is my first PSA test post RT and I had to push for this to be done. How frequent should I be having regular PSA blood tests?

I have requested, but have not yet had, any comment on PSA result from oncology.

My most recent (and third) Decapeptyl injection was on the 27 August 2021.

John

User

Posted 23 Oct 2021 at 00:20

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

User

Posted 23 Oct 2021 at 17:32

When I was first diagnosed in Aug 2018, my PSA was 27 - following various tests, it was decided I had PC, a slow grower.

Eventually, I decided to go the HT RT route - started HT in May 2019.

RT was done oct - nov (20) 2019 My HT last dose took me up to may 2020.

PSA has been low at 0.05 last year my latest one in may 2021 was 0.16 - Onco said all in line with expectations.

6 months is the normal time between PSA tests as far as I know, I will no longer have a 6 month consultation - just the PSA test. But if I have any problems, give them a call.

It took the best part of a year to get the HT out of my system & to get my "Normal" male feelings back. I have had more arm aches & pains since - but then I'm nearly 73 now!

User

Posted 24 Oct 2021 at 12:28

Lyn - what do you men when writing RT will continue doing its stuff for 18 months?

User

Posted 24 Oct 2021 at 14:53

RT has a long term action that continues for about 18 months

User

Posted 24 Oct 2021 at 14:56

Edited by member 24 Oct 2021 at 14:59 | Reason: Not specified

User

Posted 24 Oct 2021 at 15:25

https://community.prostatecanceruk.org/posts/t23233-Brachytherapy---Radiation-buildup

I posted on this thread a while back. I hope it explains the 18 month delay.

Edited by member 25 Oct 2021 at 16:59 | Reason: Not specified

Dave

User

Posted 24 Oct 2021 at 16:15

Originally Posted by: Online Community Member

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

User

Posted 24 Oct 2021 at 20:59

RT has been developed now that can deal with mets in Lymph nodes.

Port Macquarie, Australia

I hope that this will be available world wide as soon as possible. It was the treatment I received.

User

Posted 24 Oct 2021 at 21:40

The article doesn't say what the treatment is.

If it's SABR/SBRT/Cyberknife, then that's been available here in specialist centres for a while now. On the NHS, you can have up to 3 mets treated in this way. Any more than that, and the treatment doesn't work because you probably have many other micro-mets too.

Alternatively, it might be referring to whole pelvis or prostate and nodes EBRT. That's been done here for a long time.

User

Posted 24 Oct 2021 at 21:46

My RT is directed at prostate plus lymph nodes.

User

Posted 24 Oct 2021 at 21:47

Originally Posted by: Online Community Member

The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all.

Zapping the cancer cells in the prostate does slow down the progression of early mets elsewhere. Some patients with small numbers of mets are now being offered prostate radiotherapy early on to extend life. More recently, there's also been a trial of prostatectomies for the same reason (TRoMbone), but results not yet available for that.

It's thought that the mothership cancer helps support the initial mets to grow with release of chemicals.

User

Posted 24 Oct 2021 at 22:23

Andy, I'll see if I can find you a better/more scientific article on the process but the essence is that it's possible in one treatment to specifically target both the prostate and lymph glands, without blasting the whole area with radiation.

Your posts on diet and body composition scales were most interesting. I'm going to post something on that shortly.

User

Posted 24 Oct 2021 at 22:27

Originally Posted by: Online Community Member

My RT is directed at prostate plus lymph nodes.

Yes; lymph nodes close to the prostate ... they wouldn't be able to zap lymph nodes in your chest at the same time as your prostate.

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

User

Posted 24 Oct 2021 at 22:33

I don't want to divert the thread away from its original purpose so I'll keep this brief. Here's a couple of references:

targeted radiotherapy

external beam therapy

Jules

User

Posted 24 Oct 2021 at 22:39

Originally Posted by: Online Community Member

The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all.

It's thought that the mothership cancer helps support the initial mets to grow with release of chemicals.

TRombone has been running for years and we have a few members here who have either had RP or radical RT knowing that they were metastatic. My point was that RT to the prostate may slow down the development of new mets but is not going to kill the cancer at existing metastatic sites. No one is claiming that RP or RT to the prostate is potentially curative when mets are already known.

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

User

Posted 24 Oct 2021 at 22:44

All of those things are available in the UK, Jules, except proton beam therapy which currently isn't approved on the NHS as a primary treatment for prostate cancer because the results weren't very good (although it performs much better as a salvage treatment). I can't see anything about a new treatment that targets the prostate and mets at the same time?

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

User

Posted 25 Oct 2021 at 01:14

Originally Posted by: Online Community Member

I don't want to divert the thread away from its original purpose so I'll keep this brief. Here's a couple of references:

targeted radiotherapy

external beam therapy

Jules

As regards the claims for External Beam as 'cure' - we dont use this term in the UK but 'in remission'. Regardless, the claims for success are well in excess for figures I have seen reported in trials. Furthermore, whilst there are obviously cases where EBRT (IMRT or IGRT) will be the best option for some individuals, to generalise and say it is superior to Brachytherapy (Low or High Dose) long term needs evidence to support it, because the contrary is what I have read. In some cases Brachytherapy and EBRT are used as part of a treatment plan. This study of trials shows how the major treatments compare for three stages of the disease. You will find trials are segmented into an elipse for each treatment. You will need to work your way round the site. https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/

Edited by member 25 Oct 2021 at 01:19 | Reason: Not specified

Barry

User

Posted 25 Oct 2021 at 04:03

Originally Posted by: Online Community Member

I can't see anything about a new treatment that targets the prostate and mets at the same time?

Lyn, as I understand it, that is exactly what the treatment here is doing, targeting the mets in the sessions of RT that are dealing with the prostate.

Jules

User

Posted 25 Oct 2021 at 06:30

Having been told a number of times that I don't know what I'm talking about, I rather regret having said anything about this treatment. The only thing I'll add, is that it's being carried out by two large regional hospitals here, several thousand men have received it and there is no reason to believe that the outstanding results might be contrived.

If the figures are wrong, it would amount to medical fraud by a highly respected oncologist ... I find that unlikely.

Edited by member 25 Oct 2021 at 08:44 | Reason: Not specified

User

Posted 25 Oct 2021 at 08:49

Originally Posted by: Online Community Member

I can't see anything about a new treatment that targets the prostate and mets at the same time?

Lyn, as I understand it, that is exactly what the treatment here is doing, targeting the mets in the sessions of RT that are dealing with the prostate.

Jules

Jules, I have just read the links you posted and the first thing that leaps out is it refers to "Men with localised prostate cancer". That is clearly not the same as treating mets that have spread through the body. There is a major difference between "Advanced PCa" and "locally advanced PCa".

Good luck to everyone coping with the insidious big C

User

Posted 25 Oct 2021 at 09:26

Agreed. Sorry if there's a misunderstanding here. I'm only referring to treatment of lymph glands in the vicinity of the prostate and certainly not in the chest or elsewhere well away from the prostate.

Jules

User

Posted 25 Oct 2021 at 10:02

Ah okay - that makes sense. Yes, treating lymph nodes close to the prostate at the same as the prostate is possible, they can do that with radiotherapy and / or by removing them during prostatectomy. It doesn't always work because sometimes the cancer has also moved unseen to far flung lymph nodes and that doesn't become apparent until further down the line, but it works often enough to be worth trying.
I don't think any of us were saying that you didn't know what you were talking about; Australia does sometimes seem ahead of the UK in terms of treatment and it would have been exciting if they had developed some new treatment protocol.

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

User

Posted 26 Oct 2021 at 03:00

Originally Posted by: Online Community Member

Thanks Lyn. I suspect that the RT they're using here is not so much a radical new development as a refinement of existing techniques and equipment that's allowing more precise locating and targeting of cancer, particularly where Lymph nodes are concerned. The results certainly indicate some progress.

Jules

User

Posted 26 Oct 2021 at 03:29

Originally Posted by: Online Community Member

If the figures are wrong, it would amount to medical fraud by a highly respected oncologist ... I find that unlikely.

What I am suggesting is the terminology is misleading here and on some other sites too. From the links you gave there is a stand alone paragraph without any qualification or clarification stating :-

"Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer."

To me, and I beleave most people, this implies that for these two stages of PCa, if you have EBRT you are cured, to the respective percentages of cases, with no need for further treatment. However, this is a paste from the Internationally renowned John Hopkins :- "Recurrence Even if your cancer was treated with an initial primary therapy (surgery or radiation), there is always a possibility that the cancer will reoccur. About 20 percent to-30 percent of men will relapse (have the cancer detected by a PSA blood test) after the five-year mark, following the initial therapy. The likelihood of recurrence depends on the extent and aggressiveness of the cancer."

Some other sites quote up to 40% recurrence. As well as the cancer grade and type the amount of radiation and number of fractions will make a difference. So, the very high success numbers quoted originally are more likely to be for control over a certain time frame rather than cure, which I believe should be complete eradication without time limit.

Edited by moderator 07 Dec 2022 at 10:18 | Reason: Not specified

Barry

User

Posted 26 Oct 2021 at 09:38

Barry, I quite agree with you about the terminology. I would prefer to have been able to link to a scientific paper on the work rather than what is more like press release material.

As far as the treatment goes there's no assumption that after you've had RT you walk out to never return. I'm on Zoladex, in theory for three years and no member of the team who treated me ever used the word "cure".

On my first appointment post EBRT treatment I was told that my cancer, prostate and lymph glands had been "totally obliterated". I don't know if this is an unusual claim but at least it's a good start.

Time will tell of course.

Jules

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