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PSA rise after SRT........things were going so well

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User
Posted 16 Nov 2024 at 18:30

Hello friends

 

I wanted to update you and ask for some thoughts on my latest result.

 

Just to recap I had Radical prostatectomy Nov 2023.

 

9 weeks after this my PSA was 0.1. It went to 0.22 in 11 weeks and I pushed for SRT. In May/June 2024 I had 20 fractions of SRT. At the start of the treatment my PSA was measured at 0.25.

 

My SRT finished 18th June 2024 and I had my PSA checked 8 weeks after this. The great news was my PSA had dropped from 0.25 to 0.09. I was advised this was very positive and that I would check every 3 months and hope for it to come down over time to around 0.03.

 

Last week i had my 3 month PSA test (5 months from end of SRT) and my result was 0.11

 

I spoke to the urology nurse yesterday and she said that it takes at least 6 months for PSA to reach Nadir after SRT. She has advised I wait for 3.months and see how it is in Feb and that unless it starts a climbing trend, then there will be no action.

 

I don't know why, after the journey I've had over the last 18 months but I feel crushed. I'm sick of Google and trying to find answers for every scenario. Depending on what you read ranges from nothing to worry about to this is not good.

 

I'm not wanting sympathy as I know there are so many there in a more challenging position. 

 

I've also felt a full bladder feeling over the last weeks as if I had a UTI but sample came back clear.

 

Any thoughts or comments would be welcomed as mind is in overdrive

 

Take care all

User
Posted 20 Nov 2024 at 13:14

Hi Mike

Many thanks for the reply and what you have been told is pretty much what I have got from my team. Our journeys are similar except that after my prostatectomy, my psa dropped to 0.1 but it climbed quickly at the rate of 0.01 per week to 0.22 in 3 months. I have never been undetectable but also have not had ADT therapy

I had a very healthy drop after SRT so it has definitely hit the right are where microscopic cells were still active (I had positive margins in pathology and was high risk for reoccurrence) the change is only 0.02 but the stress came more from my tendency to explode the thoughts and thinkmof every possible thing this could mean which isn't healthy I know.

 

Since my post I checked my urine out to find I have a UTI and now on antibiotics and the nurse going to book me in 6 weeks to have PSA rechecked as UTI can affect PSA readings she has told me.

 

Tale care and yes it's about keeping positive and moving forward....this is a marathon and not a sprint.

 

I'll look I to the website you mention too. Thanks

 

Cheers Mike

User
Posted 20 Nov 2024 at 15:27

I think the next step for both of you is a PSMA PET scan, but there's little point doing that until your PSA has reached 0.2 or 0.5 (depending on the PET scanner). It's possible you'll never get that high if all the cancer has been zapped by the salvage radiotherapy, so there's probably nothing to do until you get to 0.2 or 0.5.

If you do get high enough for a PSMA PET scan and you want the option of curative treatments, then you need to be under the care of a centre which does PSMA PET scans and salvage SABR radiotherapy - many district general hospitals don't, and seem reluctant to refer elsewhere for thise treatment, which has been the standard of care in England for several years now. Hospitals which don't offer these will usually just put you on lifelong hormone therapy at that point, losing the potential of another curative option. (The cure rate from salvage SABR isn't high, but it's worth it even when it doesn't cure, as it typically puts off the need for lifelong hormone therapy for a couple of years.)

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User
Posted 16 Nov 2024 at 23:27
Unfortunately it sounds like your next course of action is a PSMA PET to see what has been missed.

If you only had your prostate bed irradiated there may be an option to target your pelvic lymph nodes.

User
Posted 20 Nov 2024 at 12:17

You might try asking on the PCa forum on healthunlocked.com that has a lot of knowledgeable people relating to this type of question.

I’m in the same boat, 3 months after SRT (May/June, 33 sessions, no ADT) to the prostate bed my PSA had dropped from .22 down to .10 like yourself hoping it would continue dropping. Now in Nov it remains .10

I queried with my Oncologist if had reached my PSA Nadir and was advised whilst possible it might take 18 months + for the radiation to do all its work. On the basis that it doesn’t kill the cancer cells outright rather when the cells start to reproduce. There was talk of benign prostate cells but I don’t buy that having had my prostate removed and been undetectable for 18 Months.

Having a PSA bounce ie dropping then rising before dropping again following RT is a common event. However not sure if this applies when the prostate has already been removed.

If I do require further treatment then it was suggested further SRT to the pelvic lymph nodes is a possibility. The Oncologist seemed relaxed about, much more than me! She stated that should it reach 0.30 then then would start further investigation.

Further talks with the oncology nurse said the levels the PSA can move up and down slightly as the radiation does its work. In my case they said they would be referring me back to the Oncologist is I had three consecutive rises in my PSA or it doubles ie reaches 0.20 so the nurse would react before the Oncologist.

So unfortunately, there doesn’t appear to be a definitive answer, however I have read some research papers that indicate dropping below 0.10 after RT is a positive long term indicator. At these low levels then likely the cancer is still localised.

Its important to do things you enjoy, get the support of friends and family whilst making plans for the future for many years to come.

All the best
Mike

Edited by member 20 Nov 2024 at 12:19  | Reason: Not specified

User
Posted 20 Nov 2024 at 13:14

Hi Mike

Many thanks for the reply and what you have been told is pretty much what I have got from my team. Our journeys are similar except that after my prostatectomy, my psa dropped to 0.1 but it climbed quickly at the rate of 0.01 per week to 0.22 in 3 months. I have never been undetectable but also have not had ADT therapy

I had a very healthy drop after SRT so it has definitely hit the right are where microscopic cells were still active (I had positive margins in pathology and was high risk for reoccurrence) the change is only 0.02 but the stress came more from my tendency to explode the thoughts and thinkmof every possible thing this could mean which isn't healthy I know.

 

Since my post I checked my urine out to find I have a UTI and now on antibiotics and the nurse going to book me in 6 weeks to have PSA rechecked as UTI can affect PSA readings she has told me.

 

Tale care and yes it's about keeping positive and moving forward....this is a marathon and not a sprint.

 

I'll look I to the website you mention too. Thanks

 

Cheers Mike

User
Posted 20 Nov 2024 at 15:27

I think the next step for both of you is a PSMA PET scan, but there's little point doing that until your PSA has reached 0.2 or 0.5 (depending on the PET scanner). It's possible you'll never get that high if all the cancer has been zapped by the salvage radiotherapy, so there's probably nothing to do until you get to 0.2 or 0.5.

If you do get high enough for a PSMA PET scan and you want the option of curative treatments, then you need to be under the care of a centre which does PSMA PET scans and salvage SABR radiotherapy - many district general hospitals don't, and seem reluctant to refer elsewhere for thise treatment, which has been the standard of care in England for several years now. Hospitals which don't offer these will usually just put you on lifelong hormone therapy at that point, losing the potential of another curative option. (The cure rate from salvage SABR isn't high, but it's worth it even when it doesn't cure, as it typically puts off the need for lifelong hormone therapy for a couple of years.)

User
Posted 20 Nov 2024 at 16:46

Thanks Andy for your response and knowledge on treatment options...

Yes agree with you that if PSA climbs to 0.2 I will be pushing hard for the PSMA pet scan. It will probably take some months on a waiting list so the earlier the better.

I don't know much about SABR but if it's on the table and I feel it can benefit me, then I'll ask the question.

 

Hopefully these decisions are far down the line from now and that any PSA changes are small but let's see.

 

Cheers

User
Posted 21 Nov 2024 at 19:16

SABR is radiotherapy, but done as a narrow high power beam. It's particularly suitable for aiming at the odd hot-spot, e.g. a lymph node or spot in the bone. The maximum NHS England will treat this way is 3 spots which appear after your original curative treatment. The trials showed very little benefit if more than that (and none if more than 5).

I don't think this is available on the NHS in UK countries other than England.

Edited by member 21 Nov 2024 at 19:17  | Reason: Not specified

 
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