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Rise in PSA levels post RT

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User

Posted 28 Jan 2024 at 15:09

Hello, my husband completed 20 rounds of RT in April last year and his PSA levels in November were 0.57. He has just had his next 3 monthly PSA test and this has risen to 1.78.

Should we be worried?

Thanks

Nic

User

Posted 28 Jan 2024 at 19:32

HI NS78,

I had surgery rather than radiotherapy, so I can't answer your question, but I'm just responding to 'bump up' your post.

You haven't mentioned whether your husband is having (or has completed) hormone therapy, so I assume not (?). If he still has a prostate, then he will produce PSA. It is my understanding that a small rise in PSA is not considered very significant, but other contributors on here will be able to advise you better than me.

Best wishes,

JedSee.

User

Posted 28 Jan 2024 at 19:43

Hi Nic

What was his NADIR(lowest PSA reading)? As I understand it if it goes to NADIR + 2.0 then further investigation may be required. I’m assuming he still has a prostate so will still generate a PSA.
do you not have a CNS you can speak to?

Hope you can get an answer.

Derek

Edited by member 28 Jan 2024 at 19:46 | Reason: Not specified

User

Posted 28 Jan 2024 at 20:00

Well officially you shouldn't be worried. Because recurrence is not considered to happen until a value of 2.57 in his case. Any test within about six months of RT isn't very reliable either, the rise in PSA could be from cancer cells dieing post RT.

However, that is a pretty big rise. I don't think I've seen anyone else on this site post that big a rise shortly after RT. I would be contacting the oncologist straight away.

Edited by member 29 Jan 2024 at 04:07 | Reason: Not specified

Dave

User

Posted 28 Jan 2024 at 21:29

Thank you for your replies, I really appreciate it. My husband had HT for 4 months prior to his RT but this was then stopped as he has a heart condition so it was a bigger risk to keep him on it.

I can’t remember the first PSA test result but it was just over 1. He completed RT end of April and had this test completed in August. The next reading in November dropped to 0.57 then his latest one taken last week was 1.78 which seems a significant jump.

Hopefully it’s nothing to worry about, we speak to the oncologist on the 8th Feb but feels a long wait when we’re already worried. I’ve read there can be a bounce and just wondered if anyone else has experienced something similar but it seems not.

User

Posted 29 Jan 2024 at 04:19

This link does suggest it may just be a bounce.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465291/#:~:text=In%20curative%20cases%2C%20PSA%20levels,the%20PSA%20bounce%20%5B3%5D.

It's not easy to read but it mentions a bounce amplitude of 1.3 which your OHs result is just below. I and nearly everyone on this site would have been on HT after RT so a bounce would have been masked by the HT.

It does sound like your OH could be in a better situation than it would first appear.

Dave

User

Posted 29 Jan 2024 at 10:25

Was he on hormone therapy?
If so, is he still on hormone therapy? If not, when did it run out (i.e. when would the next injection have been if he hadn't stopped)?

Edited by member 29 Jan 2024 at 10:27 | Reason: Not specified

User

Posted 27 Mar 2025 at 17:13

Hi all, it’s been a while since I posted on here but looking for some advice around PSA tests. From the thread my husband’s levels still remain above 1 (last month 1.13) I keep reading about others having undetectable PSA and just wanted to ask if this is something he would need to be worried about? My husband had 20 rounds of RT but couldn’t stay on the HT due to a heart condition and I’m just interested to know if others PSA levels are above 1 two years following treatment?

Thanks

Nic

User

Posted 27 Mar 2025 at 17:36

Hi Nic,

Your husband still has a prostate, so it’s normal for his PSA to rise a little. Normally I think if it goes 2 points above his lowest reading further action might be needed. As he has stopped HT his testosterone might be coming back causing the rise in PSA. It seems thought that is has reduced a little since your last post.

If I were you I would speak to his CNS to see what they say about it…it might give you the reassurance you need.

all the best,

Derk

User

Posted 27 Mar 2025 at 19:21

Hi Derk,

Thanks for your response, we have an appointment with the oncologist next month so will ask the question, I think in my head I thought the PSA needed to be below 1.0 following treatment but I may have misunderstood and be worrying unnecessarily!

Thanks

Nic

User

Posted 27 Mar 2025 at 20:54

I had HT&RT. My PSA was undetectable for a while but that was whilst still on RT/HT. My nadir, can't remember exactly how long after treatment finished that was, was 0.5 and for me if PSA gets to 2.5 things will be checked. My treatment finished summer 2018 and PSA ranged from 0.5 to 0.3 since then. So it could be undetectable whilst actually on treatment but after, as has been said, the prostate will produce PSA. Thing its fairly normal to look for an increase of 2 above nadir to think about checking things.

Peter

User

Posted 27 Mar 2025 at 22:27

Hi Nic,

Your husbands fluctuating PSA results could absolutely be because of bounce.

Bounce is recognised to occur more frequently in younger men after radiotherapeutic treatment. Your husband would definately be classed as a 'younger man' at 54 at time of treatment.

The PSA results you posted follow the pattern of bounce - i.e.an initial decrease in PSA followed by a spike, followed by a fall.

(3.51 pre treatment ----> pre bounce nadir of 0.57 ------> bounce spike back to 1.78 ----> fall back to 1.13)

There's quite a lot of studies into why bounce occurs but ultimately, no-one really knows.

In general terms though, younger men are more likely to experience bounce, the spike is most likely to occur within the first 12 months post treatment (a rise indicative of failure usually occurs more than 3 years after treatment) and it's not unusual for a bounce to take up to 3 years to reach ultimate nadir.

It's obviously very disconcerting to see a rise but the subsequent fall is a little more reassuring.

Absolutely, you should be discussing the implications of the fluctuations with your onco who may want to order some further investigations (MRI etc) but it does fit the parameters of bounce from what you've posted.

Basically, don't panic at this stage, there could definitely be an explanation (even if no-one can actually really explain bounce!!!), take reassurance from the pattern of fall --> rise --> fall, speak to your onco and hopefully, the PSA results will continue to fall over the coming months.

Have a google for 'PSA bounce after radiotherapy for prostate cancer' if you want to learn more about it

Best of luck

Paul

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