Slight PSA rise 9 months after radiation.

Good point! I've been using different labs. Take care.

I can't speak from my own experience for the post-radiation drop, because I'd been on ADT (Firmagon) and ARSI (Erleada) for six months by the time they radiated my prostate, and the meds had already reduced my PSA to undetectable levels.

For me, the radiation (both to the surgery site and months later, to the prostate) were just to give the cancer an extra kick while it was down. We don't fight fair with cancer any more. 🙂

Not many years ago, at stage 4b they would have given me only palliative treatment to manage pain. Now they recognise my cancer as "oligometastatic" (just one metastasis in my case, though it was a doozy) and — with my enthusiastic agreement — treat me with "curative intent," including high doses of radiation, even though it's most likely we'll just hold it at bay for years (or decades).

reading all this makes me want to add a little. I just finished 2 years of lupron ( with some casodex) in the onset. Maybe 3/4 months of appaliutimide and 39 radiations. The Psa has been undetctable for about 2 years , counting from the begginnig of treatment until now. I could not handle the erleada , it wasa toxic to me and I had to stop. The radiation had a flaw the radiologist was old school and he got to the end and ran out of ability to finnish the treatment. He did a very good job, the odd part was due to his inability to be certain of the final passes. I spoke to the MAYO Clinic, and got on the radiology patient roster incase something cooks off again. ai sent all the initial PSMA scans and the rest. They were not terrible concerned, it has been 6 months since and lupron, they want me to take a Psa reading every 3 months .Makes sense to me, so far I have had 2 3 months cycles and things are still undetectable. Testoserone is barely there. About .23 and not much it happenins there. Over all the idea is that , I being 77 years old, and considering the length of lupron it is unlikely I will recover much testoserone. I really don't miss it. I workout daily, stationary bikes etc and some weight bearing . So, the truth is I could care less about testoserone. I have regained a lot of strength. And from what I experienced so far, I never stopped the workouts throughout the treatment even thru the radiation. That part was rough. Lupron is a heavy hit. Ths last converstaion with my NP, she nenbtioned regarding testoeerone . you will eventually have a " new normal '. in other words an unknown. Have also been mentioned age will slow down or completly prevent any more . The Mayo clinic said any more may take two years I have no interst in sex, it has always been a pia all I want to do is continue exercise. The opinion from Mayo Clinic was that the initial radiaton was done very well, he was operating inder the guideline of ' curative 'methods, which I understand to be high level of radiation. '. that is my story so far . If and when the psa moves to a 2 they will have me got to the Rochester clinic and get the missing link rezapped or whatever. What else can I do .

Let’s take a look at this how it works for people that have active PSA issues

You give somebody a prostatectomy, the PSA drops to undetectable as long as no metastasis were found beyond the prostate.

You give somebody without metastasis Lupron, someone who has a PSA of from 2 to 50 (and beyond) and their PSA will drop to below one within two months. The body doesn’t keep a residual PSA. Now if they are castrate resistant then the PSA will rise above one, but there’s something in the body sending out that PSA.

You give someone radiation to the prostate, when the cancer has not spread beyond it, then their PSA drops to below one in almost every case. Exceptions are when something else is still producing PSA. Of course, if you give them Lupron as recommended by the NCCN after radiation their PSA will still drop below one.

The PSA doesn’t stick around at a higher number, because it doesn’t residually stay in the body. If you have a higher PSA then something in your body is putting out PSA.

Someone with a PSA of 3.57 after getting radiation almost definitely has something in their body putting out PSA. It could be the radiation was done incompletely If there is a metastasis somewhere, not radiated, it could be that.

9 months after radiation if somebody has a PSA above 1 or 2 they should be getting a PSMA pet scan to find out where this PSA is coming from. People don’t retain a high PSA from the past, something in their body is producing it.

According to the credible sources I can find, radiation therapy doesn't kill all the healthy cells in the prostate, so it can still produce PSA afterwards without the help of metastases. The nadir (lowest PSA) comes anywhere from a couple of months to a couple of years after radiation.

From UC San Francisco:

"Serial PSA blood tests will be used to monitor your progress after definitive treatment of your prostate cancer. Following radiation therapy, your PSA will fall but will not reach its lowest value, or nadir, immediately after treatment. Though infrequent, it may take up to two to three years for the PSA to reach its nadir."
https://www.ucsfhealth.org/education/faq-radiation-therapy-for-prostate-cancer
From the American Cancer Society:

"Radiation therapy doesn’t kill all of the cells in the prostate gland, so it's not expected to cause the PSA to drop to an undetectable level. The remaining normal prostate cells will still make some PSA.

The pattern of the drop in PSA after radiation therapy is also different from after surgery. PSA levels after radiation tend to drop slowly, and they might not reach their lowest level until 2 years or more after treatment."
https://www.cancer.org/cancer/types/prostate-cancer/treating/psa-levels-after-treatment.html#after-radiation-therapy
From the Canadian Cancer Society:

"But the PSA level usually drops more slowly after radiation therapy, taking from 6 months to a few years to reach its lowest level."
https://cancer.ca/en/cancer-information/cancer-types/prostate/treatment/follow-up
From the Prostate Cancer Foundation of Australia:

"After radiation therapy, PSA levels will drop steadily and may take 18 months or more to reach the lowest level (the nadir). Radiation therapy does not kill cancer cells right away. It may take a number of days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends."
https://www.pcfa.org.au/news-media/news/psa-levels-after-treatment-all-you-need-to-know/
Cheers

These articles don’t mention what level the PSA will drop to, just that they can take a long time to drop to near undetectable.

The PSA should drop a lot more than 3.57 after 9 months, he only started at 11. After five years of weekly meetings, I’ve never heard of anybody complaining about their PSA being above 1.5 because it was bouncing around after radiation. Maybe it’s possible, but if it were me I would want a PSMA scan

It is true that you usually don’t treat until there are three rises in the PSA after radiation.

Keep exercising. You have the right idea it works.

I’ve been on Lupron for seven years and it did give me a lot of hot flashes. I didn’t realize how much it had deteriorated my muscles until I recently had my knee replaced. I had one done five years ago, and I quickly recovered within two months. I had my second one done in March and it has taken me almost 4 months to be able to really walk comfortably. My muscles were just too weak to recover quickly and I had to do PT for four months just to get my muscles up to the point where I could walk without a limp. I now go to the gym three times a week and use exercise machines on my legs and arms. I really can’t use weights because I’ve got tendon tears in my left shoulder and even lifting 15 pounds is too much.

I got a lot of muscles back doing all the PT, it’s really beneficial.

I also walk a mile twice a day on a track across the street from my house. That doesn’t help enough, you need to do weight training.

As for testosterone, it comes back really slowly when you’re in your late 70s. My brother had radiation last year in January and was on Lupron for six months. He was still getting hot flashes nine months after stopping the Lupron. His testosterone is still only in the mid 100s. I hear a lot of people complaining about their testosterone not coming back in the weekly prostate cancer meetings I attend. It’s really tough on those in their 70s and above. With Casodex The testosterone is supposed to come back a lot quicker, but it’s not really working well for those that are older either.

@giordi Here is my data from my psa before the radiation with the Mridian linac machine (1 data point November 2022 ) to May 2024: 10.29(went to urologist) 4.61, 2.99, 1.4,1.5,0.94 and 0.73. My radiation oncologist told me that after reaching my nadir, if my PSA rises 2 points, there may be an issue. My radiation was finished on 2/15/23 with 5 fractional treatments.

Proton radiation in 2010..2 1/2 months each morning. Before: PSA: 6.47; Gleason 3 plus 3, T1A, slow growing prostate cancer in one location. Post PSA for months and years under .5. Then in 2015, PSA began to rise to current 4.37. MRI in May showed possible return or perhaps not all the cancerous cells were killed by proton radiation. I am now having the MRI results read at Mayo Clinic in Jacksonville. The MRI was done at the VA in Gainsville, Fl. The categories of 1 thru 5 with 4 and 5as "perhaps", but not absolute. In my case, the initial MRI at Loma Linda (where the proton radiation was done) indicated calcifications around the layers of the prostate. This is not a problem, but can impact the "read" of the MRI. The MRI radiologist and the person "reading" the MRI scans are very important. Mistakes do happen. Reading the MRI is subjective as to cellular formation and indications of cancer cells. So, if you are going to have an MRI, educate yourself as to the the various issues, challenges and concerns so you can ask your doctor specific questions. The challenge is knowing to ask the right questions. If you feel the responses are questionable, then go someplace else.

My PSA goes up but sometimes goes down.
.1,.2,.22,.54,21