Slight PSA rise 9 months after radiation.

I hope you reconsider. There is always something or somebody to live for. We never know what the future holds. You may meet someone or find a purpose in the future for which you want more quality time.
No matter your decisions, I wish you well and hope you find peace.

@racslider I'm so sorry to hear about the tough turns your life has taken. I'm not going to give you "why not try this simple trick?" type advice, because I know it's not that easy. Instead, I'm going to remind you of a couple of things:

1. Depression is a convincing liar. It tells you you're worthless, that life is hopeless, and that they way you feel is because of what's happening around you and is outside your control.

2. It **is** possible to feel better (even happy) no matter what is going on in your life, but it will take work, and depression is busy trying to convince you that you're too tired, or it's not worth it, or it probably won't matter anyway. Don't believe it (see item one).

Getting started and seeking help is the hardest part of recovery from depression. Others have written about it here: some found a path through therapy, some through religious faith, sone through medication, and some through community involvement and helping others. If you decide to fight depression (and I hope you do), it might take more than one try, but it's worth it. There's joy waiting for you out there behind the thick, dark curtain.

Mayo also has a forum on the topic that might be helpful:
https://connect.mayoclinic.org/group/depression-anxiety/

Racslider:
Just adding my encouragement to that from others to continue and move forward.
My philosophy is that "everything changes"; nothing stays the same. Sometimes changes are for the better and sometimes for the worse.
Since I cannot predict, I try to persevere.
I would not want to look back and regret missing the opportunity for continued life and health.
Best wishes.

There can very well be someone or somebody around the corner to live for. How about yourself? Wouldn't that be a possible reason?

I was wrong. Your relatively high PSA that keeps going down does occur with some people that receive radiation. I’ve now heard of cases where it took three years to get back to undetectable after radiation.

Do remember, if your PSA rises three times in a row you need to look into it, that can mean a relapse.

This is an old thread but there is a lot of misinformation that be said by some on this.

After radiation, if you are NOT on ADT, it can take come time to reach NADIR, and when I say take some time, anywhere from 2 to even 5 years.

and along the way, there can be what is known as a PSA bounce after radiation. It is a very common occurrence, and does not mean a failure.

The poster northoftheborder stated the standard used, and those link he provided, are from UCSF which is one of the top Prostate Cancer Centers in the country.

The one comment which is correct is your questions and concerns need to be addressed to your radiation oncologist.

The definition used by comprehensive cancer centers is if the PSA goes greater than 2.0 above your NADIR, that is when you need to investigate for reoccurrence, and usually that will be through an MRI and PSMA.

Thanks Jeff, and my radiation oncologist at UCLA said it can take up to 5 years for NADIR to be reached, and what they are looking for is .5 ng/ml or less as the lowest PSA level reached after treatment.

The important thing as you said is that the trend is going down. However, up to 30% of people experience a temporary PSA bounce on the way that does NOT indicate a reoccurrence, and what makes it more nerve racking is there can actually be several bounces along the way.

That is why it is so important to work with your radiation oncologist when you have questions or concerns.

A lot has been learned in the last 20 years, and when there is a reoccurrence they used to say if you had radiation treatment first, you could not have further radiation or surgery, but would automatically go to ADT. That is not necessarily the case any more. A lot depends on whether it is localized, regional, or distant.

This is one reason why the standard for treatment after primary radiation treatment is to treat people who’s PSA has risen 2 above its lowest after radiation. So if after months/years past treatment the PSA Drops to say .3 then they would not consider further treatment necessary until it reaches 2.3.

And @yearofthecow made this point. I just missed the last sentence of his first message.

@jeffmarc My PSA was 10.05 pre-treatment. I started on Orgovyx March 26 2025, completed SBRT mid-April 2025. July PSA was 0.36; 0.22 in October at two weeks off Orgovyx. January 2026 PSA is 0.98 at 3-1/2 months off ADT. I hope this is just an "early bounce"; last October my RO predicted a PSA rise in tandem with a rising T -- she said that 0.22 was not yet my nadir, it would be my lowest PSA ater the bounce -- that nadir can be 2 - 3 years post-SBRT. (I suspect it will be a different story if successive PSA tests will all trend towards higher values breaching 2.0 that I anticipate I won't reach before trending down towards nadir.

@vircet
The standard treatment for somebody that has radiation is to not do anything until their PSA rises two points above their low point. Sounds like that would be 2.22 for you. Jumping to .98 is not a normal up and down bounce. It’s quite a jump. Of course, dropping ADT can get your PSA to rise.

All doctors may not go by that 2 PSA rise recommendation. I think it would make sense to get a PSMA PET scan at this point. There could be a metastasis that is visible and you could have SBRT radiation on it in order to get your PSA back down.