Slow increase in PSA level after RT and hormone treatment

User

Posted 26 Oct 2021 at 14:46

It’s been approximately 3 and a half years since I finished 3 years of hormone treatment but every 6 monthly PSA test has shown an increase and it is now 1.9.

I have just spoken to my local prostate cancer nurse and she says there’s nothing to worry about and no investigations/ scans will happen until a PSA level of 3 is reached, but we can test you in 3 months

I have read on here and elsewhere that PSA level of 2 should trigger further investigation

My question is , has anyone else had a similar experience and should I be pushing for a scan when a level of 2 is reached.

thanks

Eddie

User

Posted 26 Oct 2021 at 14:57

No, I think you have misinterpreted. It isn't that a PSA of 2 0 post-RT should trigger further investigations. It is that a post-RT PSA of 2.0 + your nadir is acceptable, because you have a prostate and the healthy cells will have recovered. If your PSA rises above 2.0 + your nadir, it means that there may still be some xancer cells lurking but not necessarily that further investigation will be done at that point. At your hospital, it seems the trigger for scans, etc would be 3.0 ... at other hospitals it xan be as high as 10 or even 20!

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

User

Posted 26 Oct 2021 at 15:03

Hi Eddy,

I am a couple of years behind you, and for me at the moment I have nothing to worry about. When I came off zoladex in asked what PSA would trigger further intervention. Well 2.1 would be considered biochemical recurrence, but no investigation or action was likely until 5 and treatment would be unlikely until 10.

I guess if the only treatments available are lifelong HT or Chemo then you may as well wait until PSA is quite high.

Mind you, in the last year people have started talking of SABR treatment for Mets, so maybe a more proactive approach will be appropriate.

Dave

User

Posted 26 Oct 2021 at 15:26

Hi Eddie

I also had RT and 3 years of hormone therapy starting in 2009. By 2018 my PSA had risen to 2.4 ng/ml which was above my nadir of 0.04+ 2.0 ng/ml. At that time I had a PET/CT scan showing that there was activity in the base of the prostate extending to the seminal vesicles. It was decided that no treatment was needed at this time but when my PSA reached 5 ng/ml I would have another scan

My PSA continued to rise slowly but eventually reached 5.6 ng/ml by February of this year. I had a re-staging PET/CT scan in May by which time my PSA was 12.0 ng/ml. Unfortunately the scan showed that the cancer has now spread to my lymph nodes and perhaps to the cervical region.

I re-started hormone therapy (Zoladex) in early June and my PSA is now 0.12 ng/ml. My oncologist is keeping enzalutamide in reserve as I have responded so well to Zoladex.

The point I am making is that PSA rises can be slow and even if there is biochemical recurrence of the cancer there are still treatment options available.

Tom

Edited by member 26 Oct 2021 at 15:29 | Reason: Not specified

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User

Posted 26 Oct 2021 at 14:57

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

User

Posted 26 Oct 2021 at 15:03

Hi Eddy,

I guess if the only treatments available are lifelong HT or Chemo then you may as well wait until PSA is quite high.

Mind you, in the last year people have started talking of SABR treatment for Mets, so maybe a more proactive approach will be appropriate.

Dave

User

Posted 26 Oct 2021 at 15:26

Hi Eddie

I re-started hormone therapy (Zoladex) in early June and my PSA is now 0.12 ng/ml. My oncologist is keeping enzalutamide in reserve as I have responded so well to Zoladex.

The point I am making is that PSA rises can be slow and even if there is biochemical recurrence of the cancer there are still treatment options available.

Tom

Edited by member 26 Oct 2021 at 15:29 | Reason: Not specified

User

Posted 27 Oct 2021 at 11:17

Thanks all for the replies,
I’ll just have to calm down and wait for the next test.
Cheers
Eddie

User

Posted 27 Oct 2021 at 15:51

A small number of people are seen to have a tumour identified in their Prostate by scan post RT even with a PSA of less than 2+nadir. I was one of them and was given Focal Therapy (HIFU). However, with such a low PSA it is more than likely that the cancer cannot be seen and even if it could be seen many hospitals will not treat further until the PSA reaches 5 or 10 or may be even higher.

Edited by member 27 Oct 2021 at 16:51 | Reason: Not specified

Barry

User

Posted 29 Oct 2021 at 07:57

I had a RARP and EBRT at Addenbrookes in 2009, after which my PSA rose slowly but steadily from 0.06 in 2010 to 0.25 by 2014.

At that point the oncologist discharged me saying he did not want to see me again until my PSA had reached at least 10, and even then he would probably not want to take any action until it had reached 15 or maybe even 20.

By 2019 my PSA had risen to 1.8 but then by April this year it had jumped to 6,9 then a month later 8.2. Was referred back to hospital by my GP who did not want to wait until it reached 10. It continued rising to 9.4 by June but by September it had plateaued at 9.5.

PET and MRI scans at hospital showed nothing definite enough to take action, so the onco has decided to wait and see what happens to my PSA. I'm now due another PSA test in January 2022 and have an appt to review early Feb.

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