PSA up at the 3 month point . Looking for guidance

I'm sorry for your news.

Since you're off ADT currently, my guess is they'll probably just keep watching your PSA for now, then put you back on ADT once you hit a certain threshold (I'm guessing that threshold will be much higher than 0.39).

Then, if your PSA comes back down, they might give you another PSA holiday until it starts rising again. Rince and repeat.

Research has shown that the on-again, off-again approach is fine for early-stage prostate cancer, and improves your overall quality of life (it doesn't seem to be safe for advanced-stage cancer, alas).

If your PSA is significantly higher in this next test, then you may need to go back on ADT. Something in your body is creating lots of PSA and that most likely is your prostate. At this point they’re looking for doubling time, and three rises in a row. You might want to switch to monthly blood tests.

The ADT depresses your PSA level. It is higher because you are off the ADT.
Stay Strong Brother.

Prostate Cancer Foundation pcf.org info: After radiation as primary tx, PSA drops over time to a low point (nadir) and then can "bounce". Recurrence is defined as a 2.0 increase over nadir after more than 1 consecutive tests.
Your numbers may be fine, and that is the discussion that you will have Tuesday.
My point is that I would try to remain as calm as possible.
Best wishes.

There was a thread just the other day involving proton therapy and these wildly bouncing PSA numbers that took 5 years to finally head downward toward undetectable.
So perhaps this swing is something inherent in proton therapy?

I did not have hormone treatment but from reading posts it certainly reduces PSA numbers.

My R/O stated I will have bounces in PSA numbers. There are all kinds of reasons PSA numbers can rise including lab tests. For many many years I had a PSA number of .75. It was only when that started to rise that my PCP became concerned.

I am now at the 1.6 years since radiation (proton) ended. My PSA was going down and down but a slight rise last PSA of about a .11 rise from in the .44 to the .55 area (don't remember the exact number). My R/O stated to me the rise in PSA numbers is not something to be concerned with and it will happen (UFHPTI is and has done many years of research).

I was told you can even have different numbers from different labs. My R/O says their goal is to have it below 1.0 which it is. I can feel that my prostate is recovering from radiation as the side affects are slowly going away.

My PCP years ago said to me that (Mayo) had moved away from doing routine PSAs but then statistics were showing an increase in stage 4 prostate cancer increases and could be directly related to the common practice before of doing PSA test. So PSA tests came back big time.

I trust my PCP and R/O as far more knowledgeable than I along with decades of treating prostate cancer and the common side effects including PSA numbers bouncing around. If you still have your prostate you are going to have PSA above non detectable and depending on you specifically can bounce around and not be an indicator of cancer. If goes back to PSA numbers continuing to rise on an on and not a bounce here and there.

Have you always had your PSA tests at the same time of day? I was surprised to learn PSA is higher in the morning and lower in the afternoon. https://pubmed.ncbi.nlm.nih.gov/31390085/

@chamblee54
With radiation your prostate is under bombardment and undergoing damage to cells. It takes a long time for it to get back to normal.

Your last PSA was still very low. Were you advised that you would get bumps on your PSA which are completely normal to occur.

If you have a prostate you are going to have PSA numbers, and they will bounce around. With prostate cancer it is the long-range testing and the continued rise that is key to further diagnosis.

I did not have hormone treatment but can see it really reduces the PSA numbers after treatment than just radiation alone. My PSA went from 3.75, to .95, to .55. to .44 then a bounce to .51. I was told completely normal to have a bounce here and there and it was the long-range testing that shows more increase over time that shows more diagnosis needed to what causing.

Do you take any supplements for prostate? If not, ask your R/O and/or urologist about them.

It looks like your Doctors decided you are a good candidate for Intermittent Hormone Therapy. Based on what I learned from my visit with Dr Schulz of PCRI, I would not worry. I am no expert!
Best

Well, a single data point may not constitute sufficiency for decision making.

With the recovery of T and an intact prostate, it may be a sign of recurrence.

You may want to talk with your medical team about subsequent PSA testing frequency, do you stay with every three months or do monthly...?

A single PSA by itself may not provide the clinical data to inform decision making between you and your medical team. Generally, three PSA tests, same lab, same routine - time of day, pre-draw routine, spaced three months apart, will provide evidence of a trend. It will also give you PSADT and PSAV and if it increases, reach a point where a PSMA PET CT may show where the recurrence is. You can discuss with your medical team the "risk" of letting the PSA increase and any tradeoffs in say acting on the data you have now versus waiting for clarification. My experience is it's negligible and the clarity behind the additional clinical data results in a better decision.

When you have that type of clinical data plus your past history, it can better inform your treatment decision. As to your medical team, if not already, besides a urologist and radiologist, include an oncologist.

You say "Trying to anticipate the Drs reaction and suggestions for further treatment..." Were it me, I would ask about the subsequent PSA testing - frequency and number, imaging, when and with what, then gather that additional clinical data and decide then.

Kevin