Rise in PSA 6 years after RT

Hi,

From what I've seen an increase of 2 above the nadir or 3 increases in psa should be investigated.  Did you have a psma scan or an mri last year.  A psma scan can see smaller lesions and that should be preferred.  Some places don't like spending the money as they haven't got a psma scanner.

I've no experience of RT but if it was me I'd be looking for another opinion. Perhaps a PCUK nurse by phone or ask to meet an Oncologist at the hospital. Perhaps a private second opinion.

I was told I could have a psma scan at 0.5 on the NHS if it reaches that, after surgery. Also I could pay for one earlier.

There are more treatments available,, such a focal,  and I wouldn't want to miss out because it got too high.  If it rose by a third in 6 months it could become 4 by July and 5,2 by next Jan although you can't forecast accurately.

I wouldn't normally reply to an RT type query but I noted you said no-one replied to your last post. I had my treatment, surgery, around the same time as you and have been on here 7yrs so picked up some stuff and perhaps someone else will answer. All the best Peter

DH had brachytherapy 9 years ago. PSA went down to 0.01 where it stayed for many years. About 4 years ago it started to increase. Slowly at first. Consultant said he would see dh when it got above 2.1 DH phoned through his result when it was at 2.0. He still said no but to test in 3 months. 3 months later it was 2.7 so he had an MRI nothing showed, consultant said no cancer in prostate, so brachy had worked, however psa was now 3.7 So suggested DH had a psma scan, plus another psa test that came back at 4.9 so it was increasing quickly. The psma scan showed cancer cells in the lymph nodes in his pelvis and chest. I’ve still no idea how it gets into the lymph nodes further away without being in the nodes near the prostate. Gleason was 3+3 which apparently doesn’t spread. So who knows? So I would insist on a psma scan if you can. Your psa isn’t increasing very fast though, so hopefully all is ok. 

Thinking more about this, I am not convinced the rise in PSA is anything to do with prostate cancer. If despite the PSA having risen significantly if there are any cancer cells there they have not grown to visible size in the three years since the last scans and presumably are too small to cause issues and if they continue to grow that slowly not cause issues in the future. More likely there is no cancer in the first place and all we are doing is trying to reduce a PSA rise which may be from unrelated causes. Going onto hormone therapy for this reason seems a tad extreme.

Or am I being too simplistic?

Just flicking through this thread.  Yes the prostate  that is left after radiotherapy will produce psa, and presumably if the prostate is a bit large will produce more.  I think the thing is though, prostate cancer cells produce more psa than healthy cells, so you could have no re-occurence of the cancer, but still having a rising psa, and as I understand it, it is the rate of the rise, or the doubling time that raises red flags.

What I have become inclined to do these days is err on the side of caution, scans and biopsies are not pleasant, but I would much rather have several of them and everything is normal, than think oh well might as well leave it and something is wrong. If I had taken that view about my active surveillance scan, and pushing for it, I'd not have been in the fortunate postion of having radiotherapy that is designed to be curative. 

Similarly for me, nothing showed in lymph nodes or seminal vesicles.  Before putting me forward for radiotherapy though, I had a nuclear bone scan where they injected dye and I had to wait for several hours, then went into the scanner.  This would have showed any metastatic cancer, and didn't.  Therefore they went ahead with the radiotherapy plus hormone therapy ongoing for 9 more months.  After the radiotherapy ends next week, not sure what I will get after that. 

The problem with any cancer is that it can return, even though it was supposedly got rid of initially.  This is why they will never say you are cured, only in remission.  It may be that whatever is inside that particular body, which predisposed them to get the cancer in the first place, is still there because you are as you are.  Hence why it can return after many years.  

I know several people who have had breast cancer, not a genetic one, who had surgery, radiotherapy, hormone treatment for 10 years and were supposedly 'cured'.  But it came back.  I do think though, that anyone who is not happy, or concerned about the way they are being managed, should ask for a second opinion, it is something you are entitled to.  I am very much of the opinion, if something doesn't feel right, it's your body listen to it.