PSA rising after 16 years

Hi Lesley,

Sorry it's returned after all those years.  I haven't heard of that before.

I can't offer help on that but suggest you change your screen name to an anonymous one and not your email as it's said these posts can be found on line.

Regards  Peter

Hi Peter,

It was a bit of a surprise for it to return but the consultant said it was unknown why…. but it’s thought the original EBRT put some of the cancer cells into a long sleep/ dormant state and it has now reactivated.  We are fortunate it is in the prostate with no current spread.  Dave is now 73 and removal has been ruled out due to age and possibly collateral damage.

Lesley

I think old Barry https://community.prostatecanceruk.org/default.aspx?g=profile&u=2428

Has experienced this. EBRT years ago, followed by HIFU and then a second round of HIFU.

Hi Lesley,

Sorry your husband needs salvage treatment due to failure of Primary EBRT. Unfortunately, this sometime happens even after a number of years. Some cancer cells can be radio resistant and survive to become a challenge in time. If this is the case here, I would ask my Consultant whether further radiation might work better the second time, albeit administered in different ways as proposed. Could it be that an alternative way of attacking the cancer cells using a Focal Treament might be more successful? I would suggest hubby gets referred to UCLH for an opinion, which the Royal Marsden did for me, as I was under their care at the time having had failed EBRT. It did take two administrations of Focal Treatment, in my case HIFU, to irradicate the cancer cells - click on my Avatar for details.

At the time, Focal treatment was the only non systemic way of treating failed EBRT other than Prostatectomy. Not all surgeons will do the later due to greater difficulty of the operation after previous radiation. Also, the risk of incontinence increases greatly. UCLH will not administer Focal Treatment if they think there might be any cancer outside the Prostate and might require a PSMA and or MRI scan to determine this. (They wouldn't even rely on the Marsden's MRI in my case). Also the patient must be suitable.

I was not not offered any further RT as an alternative option but things have moved on and is now being done. The Marsden do a narrow angle type RT and the tial alternative is as here :- https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-further-treatment-prostate-cancer-has-come-back-prostate-after-previous-radiotherapy-ro-pip#undefined

Greater choice makes it more difficult to decide but I always like to consider all that is on offer and discuss with all disipline Consultants before taking the plunge. This is particularly important with Focal Therapy as it's only fully understood by those specialing in the relatively few places that administer it, UCLH being the leading place. All treatments have their failures and successes and those as offered here as salvage treatment don't have a long period of use to know mid to long term outcomes.

Edited by member 10 Jun 2025 at 01:29  | Reason: to highlight link

I share Andy's thoughts on this. The original cancer is probably eliminated. You are then left with a man (in my case aged 54) with a prostate and no cancer. However if you have a man with a prostate, we know about 15% of them will develop clinically significant prostate cancer. In my view eliminating the first cancer makes no change to the chances of another one developing. Indeed the fact the person is probably genetically predisposed to cancer makes it quite likely.

The main thing to consider is that it is probably going to be between 10 and 30 years before another cancer develops, and if the original treatment was to a man in his late 60s, something else will kill him before the cancer returns. For anyone originally treated by anything other than prostatectomy aged less than mid 60s we really need to be vigilant of developing prostate cancer (again).

RO-PIP will be interesting.

I mentioned the possibility of it being a new tumour, before Andy (I'm not just a pretty face, beer swiller, you know 🙂). However, Lesley's response suggested that the consultant doubted it was. 

 The chance of another prostate cancer tumour growing after EBRT was one of the reasons I chose surgery.

Having said that in a recent thread I posted:

I was Gleason 9(4+5), PSA 7, T3a (extraprostatic extension) and had my RARP over two years ago. I was lucky and had negative margins. So far my PSA has remained undetectable at <0.02.

However, nomograms:

https://www.mskcc.org/nomograms/prostate

suggest that my chances of remaining BCR free after 5 years are 63%, after 7 years 49% and after 10 years only 37%. This mystifies me. Logically, I'd have thought the longer your PSA remains undetectable the less chance you'd have of BCR?

It seems to me whatever treatment you have, there's still quite a chance, whether it's BCR or a new tumour, that it'll come back and get yer!

Edited by member 11 Jun 2025 at 09:33  | Reason: Typo

Everything connected to jfd has just  f***ing disappeared. 🙂

It's wrong. There was a lot of stuff that was  not related to 'our spat' that got obliterated, including posts that were pertinent to this particular conversation. 

Anyway, mate,  in relation to your "Adrian, those figures look a bit pessimistic. A BMJ article on the PIP trial works on 13% recurrence within 10 years" 

I believe that trial dealt with BCR after RT and not surgery. Even then it appears very optimistic compared to other studies on BCR after whatever primary treatment. I've just been doing some more research into nomograms, but I'll start a new thread on it, rather the hijacking Lesley's. 🙂

Edited by member 12 Jun 2025 at 09:34  | Reason: Typo

Welcome back jfd. I hope you'll continue to share your experience and medical knowledge, particularly if you choose SBRT.

Sorry about my earlier brusqueness but congratulations on using the word twixt! Excellent word that needs to be used more often.

Jules

JFD, I had surgery back in 2014 followed by salvage RT in 2017. I then had SABR which I believe is the same as srbt, in 2022 to a lymph node followed by more SABR to another lymph node the following year. My PSA then accelerated quicker than ever before and another PSMA scan revealed spread to multiple lymph distant lymph nodes.  The dates and figures are all in my profile. I started HT about five months ago.

Thanks Chris 

The waiting game is excruciating!

Thanks jfd, both for your reply to me and the information you posted to colwickchris. I'll have a look at the latest from Pub Med. My primary EBRT treatment was given to me here in Port Macquarie, where the team was leading the pack with RT to lymph nodes delivered at a higher Gy rate than had previously been the case and taking advantage of the improved precision of LINACs now in service. So far, so good. The team informs me that they are now using SBRT for recurrence.

All the best for the ongoing success of your treatment. More generally, for those with the cloud of BCR hanging over their heads, improvements in detection of mets by new types of scans would be a huge advance.

Jules

Port Base hospital jfd. Here's the Pub Med extract:

Prof Shakespeare trial

The trial ended about 6 years ago and the 5 year results are informally in, with good results. 5 years possibly doesn't tell us much when most of the patients were on ADT for 3 years but it's 100% survival, apart from one person who died from something other than prostate cancer.

I think Port has now moved on to a different form of primary RT treatment but while the hospital does great work, it's hard to get any information out of them.

You're on a very slow doubling time, so your evaluation of the  battle between a cardio-vascular and a prostate fate looks realistic. My latest psa test went down, so maybe the .6 was bounce. 

Jules