PSA wrong direction after IMRT - What do you guys think?

If all you have had is IMRT radiation As your primary treatment then the standard of care is that they wait until your PSA hits two points above the minimum it ever hit. That means you wait for it to hit 2.19.

The small increase you see is really just not relevant yet. The PSA can bounce around for a while after radiation. That is a very small change.

@jeffmarc

Cool...thanks, Jeff! An irrelevant PSA is fine by me. 😁

@mjp0512
If I read you originally post right you have been on ADT since 6/7/25 which resulted in the drastically reduced PSA levels.

Your radiation treatments ended 10/27/25. You had a PSA done 2 months after radiation ended. Normally (speaking for guidance from Mayo R/O and UHFPTI R/O) they do a PSA 3 months after radiation.

Please talk to your R/Os and urologist. When your prostate goes through radiation is very traumatized and irritated. Your PSA is extremely low but I nor any others know the parameters of your lab and what is undetectable range. If you have a prostate you are going to have PSA and completely normal. It is the rising of PSA over time and time that is a concern. You should be happy about your PSA. Your PSA will bump up and down for years. My R/Os goal is for my PSA to stay below 1. I am at .12 now.

I am not familiar nor is anyone else the lab your medical providers use. In my case Mayo Jacksonville they do not post any numbers below .10 as considered undetectable. What your lab uses for undetectable should be discussed with your medical providers as none which will give you a more accurate basis for numbers given to you.

Hormone treatments starve your PC they do not kill it (per my urologist and R/Os I am not a medical professional). Radiation damages (again from my R/Os) the cells of your PC and they unlike regular prostate cells cannot repair themselves and die. Thus it takes time to get to your base PSA which can take years.

You are only 2 months from your last radiation treatment. Again I did not have a PSA done until 3 months afterward with the caveat of from my R/Os is done earlier your prostate is not a happy camper and highly irritated after being bombarded with radiation

Asked your doctor about what the lab he/she uses that signifies what is considered undetectable. How long were you told you would be on ADT?

@jc76

Thanks jc...some good points. I do need to find out what number is considered undetectable. I'm pretty sure it's 0.10 but I'll ask during Wednesday's appointment. I'll be on ADT minimum of 2 years so long as it's working.

I just finished IMRT on November 18 for a local recurrence (had a RARP in 2015). Going in, my PSA was basically 0.1. (usPSA from Labcorp = 0.094; regular PSA from Quest = 0.11). Won’t retest PSA until February 18 (3 months post RT). As has been stated already, a recovery period from the radiation is needed to get any meaningful numbers. I had a good discussion with my RO about the clinical significance of small variations in PSA tests and especially in ultra sensitive PSA tests. She made it clear that my PSA could bounce around for a good long while (as in many months), and that she would only be concerned when there was a consistent upward trend beyond 0.1.

I totally get your angst about PSA values post treatment (I’ve been doing this for ten plus years), but I’ve also come around to rounding off those last digits given that they can be simply due to lab variations (I’ve read that lab testing can vary by ~20% at low PSA numbers). To me, 0.19 and 0.23 are within limits of lab variance.

I found these short articles helpful:
https://www.pcf.org/patient-support/diagnosis/monitoring-detecting-recurrence/part-four-psa-after-radiation-therapy/
https://biologyinsights.com/is-0-04-psa-considered-undetectable/
https://scienceinsights.org/what-is-considered-an-undetectable-psa-level/

@mjp0512
It is good to know the lab you are using undetectable number. As you can see from other post the numbers are all over the place as to what is undetectable number at labs.

Labs use different equipment and test procedures so it is good to know what yours is going to use. Did your doctors remind you to use the same lab for all your test? That guidance goes along with different labs numbers and what they use as undetectable.

Good luck at your appointment.

I did not have ADT. I was originally going to have it based on my original diagnosis prior to Decipher as I was intermediate risk. The Decipher came back low risk and the recommendation for hormone treatments was removed.

@mjp0512
Actually, the number is < .1. That is what the medical community considers undetectable.

@melvinw

Thanks for the links, melvin. Very focused and helpful. 👍

> What was your Gleason score at the start of treatments (and the reason you were on doublet therapy)?

> Are you still on Orgovyx? (For as long as the hormone therapy is in your system and your testosterone remains suppressed, your PSA should remain nearly undetectable.)

> What is your testosterone level now?
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My experience —> I received 28 proton radiation treatments during April-May 2021 (@ 2.5 Grays per session). I had Eligard injections in April & July 2021; the hormone therapy remained in my system through January 2022. It was only after the hormone therapy left my system and my testosterone level began to rebound did my PSA levels increase and then somewhat stabilize. (I charted my PSA results.)

@brianjarvis

Hi Brian

> Gleason 9 (5+4) - (full Dx in my profile)

> Yes, still on Orgovyx which is why I questioned the PSA rise in the first place, but then realized it's only been 5 weeks and 2 days since radiation so what's left of my prostate is probably still pretty irritated causing the slight bump.

> Blood for T level was drawn this past Wed. but results not posted yet.