Psa bounce

It probably is, this soon after radiation. Wait for the next test to see what’s going on. You could call your doctor and ask for an test after two months instead of three, if you’re really worried.

Thanks Jeff. My radiologist seed very concerned but my urologist thinks it just a bounce. Both would prefer I wait another 3 months before psa test.

Keep checking PSA and look for a trend.

Did you have a PSMA PET scan prior to treatments? Did you have a biomarker (genomic) test?

PSA is expected to be below 0.50 following standard radiation treatments (and if ADT was used, after ADT was out of the system). You should ask your RO if the first PSA of 0.9 was normal and expected.

As for PSA bounce, that’s common following SBRT and brachytherapy (where there is an intense radiation dose); it’s less common for standard treatments of IMRT and proton. Also, PSA bounce is said to occur at 12 - 18 months out (and as far out as 2 - 3 years), and not usually so soon after treatments.

Watch this closely with another PSA test. (Since this is regarding radiation, I’d listen to my RO.)

Hi Brian. I did have a PSMA pet scan before treatment that showed no spred. My gleason score was 3 + 4 but my Decipher was .95. That's when we did the PSMA scan and a decision was made against ADT. It's a bit early for a bounce but I'm hoping for the best.

My MO stated: no decisions should be made on one PSA reading for planning a variety of tests not needed.

It’s great that you used other test results to help in the decision.
> With your 3+4, what % was “3” and what % was “4”?

Hopefully, the recent PSA spike is just an aberration.

> How many sessions of radiation did you have?
> Did you use a rectal spacer (SpaceOAR, Barrigel, or BioProtect)?

On one occasion when my post-treatment PSA was a bit higher than expected, we repeated the PSA test in just a few weeks rather than waiting a few months. (Just something to consider bringing up with your RO.)

My biopsy report stated approx 10% 4 so I guess it would be 90% 3. It also stated 70% of the tumor is cancer. I'm not sure what that means. 14 cores were taken and only one showed the cancer. I had 28 imrt sessions and I did have Barrigel and 3 gold markers installed.

Sounds like you covered all the bases.
> NCCN guidelines do not recommend ADT for just a 3+4=7.

You had asked what are the chances it's just a bounce?
> what was your PSA pre-treatment?
> though negative for spread, what SUVmax score was assigned to the prostate lesion?
> how much radiation (in grays) did you get each session (or in total)?

Psa was 5.1 before treatment. I don't see a Suv max on my PSMA report. Report notes tracer binding activity in both central lobes of prostate. I received 65 grays total. I hope the treatment was aggressive enough!

Just like with most every other test/scan for prostate cancer - PSA, MRI (PIRADS), biopsy (Gleason), Decipher (decipher score), etc. - a PSMA PET scan always results in a “SUVmax” score, which indicates the aggressiveness of every instance of tracer binding activity they see.

You mentioned that they noted “tracer binding activity in both central lobes of prostate.” They should have then indicated SUVmax scores for both of those. (If not, you should ask what those SUVmax scores of tracer binding activity were.)

Here’s a (very lengthy) explanation of how they use the SUVmax scores to determine cancer location and aggressiveness:

As it turns out, PSMA (prostate specific membrane antigen) is not really “prostate specific.” There are other organs, tissues, and fluids that naturally express PSMA (without being cancerous) and will show as tracer uptake on a PSMA PET scan - particularly in the lacrimal (tear) and parotid (salivary) glands, blood, liver, spleen, pancreas, ganglia, and more, as well as the kidneys, ureters and the bladder (as the body tries to quickly excrete the radioligand that was injected).

“SUV” stands for “standard uptake value” and is a measure of radiotracer uptake that indicates how high grade the cancer is. The higher the SUVmax, the more advanced the cancer.

They use the PSMA SUVmax values of your blood (the lowest level), liver (the medium level), and parotid or the lacrimal glands (the highest level) of SUVmax tracer binding expression for comparison.

If a suspicious area (lesion) is expressing PSMA, and it has:
> a PSMA SUV score less than blood, then it’s not likely cancer, but instead just normal, background PSMA cellular expression;

> a PSMA SUV score greater than blood, but lower than liver, then it’s likely low-grade prostate cancer;

> a PSMA SUV score greater than liver, but lower than lacrimal/parotid glands, then it’s likely moderate-grade prostate cancer;

> a PSMA SUV score greater than parotid glands, then it’s likely high-grade prostate cancer;

That PSMA PET information - in addition to PSA, MRI, biopsy, decipher, etc. information - helps guide them in developing the appropriate treatment for your specific disease.

As always, discuss all this with your doctor when you get your SUVmax scores from them for your PSMA PET scan report.