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PSA increase after radiotherapy

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User
Posted 07 May 2024 at 20:11

My husband completed radiotherapy. PSA 6 weeks later has increased. 
oncologist said this can happen if it’s tested soon after treatment, but we were hoping for, and expecting a decrease. 
Has anyone else had this and then it’s dropped? 

User
Posted 11 May 2024 at 10:51

Hi, Turkey2222.


I am 17 months post-RT (37 fractions), 24 months post-chemo (six cycles) and have been on HT (Zoladex) since my diagnosis for locally advanced PC in late 2021. A scan post-RT showed that my PC had shrunk considerably. Initially, my PSA was 'barely detectable' but more recently it has been rising, doubling at every test. I had a couple of PET scans 10 days ago and will receive the results from my oncologist in another 10 days time. Hopefully these scans will help explain the cause of this rise and dictate my ongoing treatment.


So, from personal experience, PSA can rise after treatment - even a long time after treatment - but I have yet to find out why.


Fingers crossed for a drop in your husband's next PSA test.

User
Posted 14 May 2024 at 07:56

Originally Posted by: Online Community Member


 


yes he was offered removal, RT or AS but he decided AS was not for him for a number of reasons. 


so, is the fall in PSA not expected at this early stage? 



No RT doesn't work like that, it doesn't zap cancer cells to oblivion, it just damages them so they are unable to replicate, they will die off naturally, but I believe this can take up to 18 months, until then I think they can add to the PSA levels, so generally your husbands PSA would be expected to fall over the next 18 months, but as he still has a prostate it's unlikely to reach an ultra low level even then and there may be blips along the way which will be more noticeable as he already has a low PSA level also as it sounds like he previously had an infection he may be susceptible to them and these can artificially increase PSA level. 


I'm still suprised that a PSA test was conducted so soon after RT. I do think you need to have a good conversation with your consultant the next time you're scheduled to see or speak with him/her, mainly for the reassurance that focusing on PSA results or conversations on a forum are unlikely to give you, but from the details you've given there doesn't seem anything to worry about.

Edited by member 14 May 2024 at 08:02  | Reason: Not specified

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User
Posted 09 May 2024 at 06:31

Hi Turkey2222


what were the readings before and after RT ?


I don’t have an answer or opinion, but also interested to hear from anyone that does. I’m 1/2 way through RT and expecting a PSA test 6 weeks after.


Bumping to the top….


 

User
Posted 09 May 2024 at 06:58

It’s been all over the place.


4 2022


20.15 in July 2023 lead to tests. October it was down to 2.7. RT ended 13/3 and PSA 6 weeks later is 3. 

User
Posted 09 May 2024 at 09:20
My onco has said that it can take several weeks for the PSA to drop after completing the RT so he won't be testing me straight afterwards.
User
Posted 09 May 2024 at 13:48

Turkey, if I understand it correctly he still has a prostate. Is it still possible to  get an infection that will raise the PSA level. 


I think many of us have asked what causes fluctuations in PSA and never got a definitive answer. Lyn's ,cells  screaming as they die is always a possibility.  


Thanks Chris 


 

User
Posted 09 May 2024 at 20:07

completed RT December 2023 onco said no PSA test for 6 months , first one on May 22nd .


 

User
Posted 10 May 2024 at 08:25

I think the soonest it's normally tested after RT is 12 weeks, so there may not be much experience here of what it is before that.


What sort of RT? It doesn't sound like he had HT, so I'm guessing possibly SABR in 5 sessions? That's relatively new, which also means there may not be much experience here. The people in my support group who had this didn't get a PSA test until 6 months.

User
Posted 10 May 2024 at 09:37
There are quite a few things that cause a higher than normal PSA reading - If you have had sexual activity a few days before the test, or had an infection eg tummy upset.
Whether or not you had Hormone therapy previous to the RT treatment. I had that & low PSA readings, before & after RT.
Was the RT treatment, the older 20 visits to the hospital - or the recently introduced - less episodes, but more powerful RT?
User
Posted 11 May 2024 at 08:08

Originally Posted by: Online Community Member


I think the soonest it's normally tested after RT is 12 weeks, so there may not be much experience here of what it is before that.


What sort of RT? It doesn't sound like he had HT, so I'm guessing possibly SABR in 5 sessions? That's relatively new, which also means there may not be much experience here. The people in my support group who had this didn't get a PSA test until 6 months.



 


he had 20 sessions of radiotherapy external, not brachyhtherapy. No hormone treatment. 

User
Posted 11 May 2024 at 10:51

Hi, Turkey2222.


I am 17 months post-RT (37 fractions), 24 months post-chemo (six cycles) and have been on HT (Zoladex) since my diagnosis for locally advanced PC in late 2021. A scan post-RT showed that my PC had shrunk considerably. Initially, my PSA was 'barely detectable' but more recently it has been rising, doubling at every test. I had a couple of PET scans 10 days ago and will receive the results from my oncologist in another 10 days time. Hopefully these scans will help explain the cause of this rise and dictate my ongoing treatment.


So, from personal experience, PSA can rise after treatment - even a long time after treatment - but I have yet to find out why.


Fingers crossed for a drop in your husband's next PSA test.

User
Posted 11 May 2024 at 23:05

Originally Posted by: Online Community Member
he had 20 sessions of radiotherapy external, not brachyhtherapy. No hormone treatment.


That's quite unusual in the UK without HT.

User
Posted 12 May 2024 at 21:14

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member
he had 20 sessions of radiotherapy external, not brachyhtherapy. No hormone treatment.


That's quite unusual in the UK without HT.



 


We did query this, but oncologist said no need for HT. I think that’s what’s worrying me, as well as him not having a new MRI before RT despite 6 months between initial MRI suggesting pirads 5, biopsy saying G6 and the consensus being the MRI being at odds with the biopsy and falling PSA was  likely to be because of prostatitis. 


Worried sick if I’m honest. 

User
Posted 13 May 2024 at 07:45

There's a few details lacking such as your husbands age and full results of biopsy, but with a low Gleason score and low pre RT PSA they have assessed this as low risk cancer, were you offered active surveillance as opposed to immediate treatment?


Not prescribing HT is also another indication that they deem it low risk with a good prognosis and there's every reason to believe they are correct.


The surprising element is that a PSA test was done only 6 weeks after RT as it was unlikely to show a fall. Was the test expressly scheduled by the hospital, was it just part of the regular testing by your GP or did you request it?


 

Edited by member 13 May 2024 at 15:28  | Reason: Not specified

User
Posted 14 May 2024 at 06:37

Originally Posted by: Online Community Member


There's a few details lacking such as your husbands age and full results of biopsy, but with a low Gleason score and low pre RT PSA they have assessed this as low risk cancer, were you offered active surveillance as opposed to immediate treatment?


Not prescribing HT is also another indication that they deem it low risk with a good prognosis and there's every reason to believe they are correct.


The surprising element is that a PSA test was done only 6 weeks after RT as it was unlikely to show a fall. Was the test expressly scheduled by the hospital, was it just part of the regular testing by your GP or did you request it?


 



 


hes 67


mri was pirads 5


biopsy Gleason 6


 


PSA 20.15


5.8


2.7


 


then after RT 3 - scheduled by the hospital 


 


yes he was offered removal, RT or AS but he decided AS was not for him for a number of reasons. 


so, is the fall in PSA not expected at this early stage? 

User
Posted 14 May 2024 at 07:56

Originally Posted by: Online Community Member


 


yes he was offered removal, RT or AS but he decided AS was not for him for a number of reasons. 


so, is the fall in PSA not expected at this early stage? 



No RT doesn't work like that, it doesn't zap cancer cells to oblivion, it just damages them so they are unable to replicate, they will die off naturally, but I believe this can take up to 18 months, until then I think they can add to the PSA levels, so generally your husbands PSA would be expected to fall over the next 18 months, but as he still has a prostate it's unlikely to reach an ultra low level even then and there may be blips along the way which will be more noticeable as he already has a low PSA level also as it sounds like he previously had an infection he may be susceptible to them and these can artificially increase PSA level. 


I'm still suprised that a PSA test was conducted so soon after RT. I do think you need to have a good conversation with your consultant the next time you're scheduled to see or speak with him/her, mainly for the reassurance that focusing on PSA results or conversations on a forum are unlikely to give you, but from the details you've given there doesn't seem anything to worry about.

Edited by member 14 May 2024 at 08:02  | Reason: Not specified

 
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