← Return to What are the chances that this is just a PSA bounce?

Discussion
billybarnes avatar

What are the chances that this is just a PSA bounce?

Prostate Cancer | Last Active: Jan 16 11:01pm | Replies (19)

Comment receiving replies
Profile picture for vircet @vircet

@brianjarvis I was on Orgovyx starting March 26 and had my SBRT treatment in mid-April 2025. Three months post-SBRT my PSA ws 0.36; six months post-radiation and at two weeks off Orgovyx my PSA was 0.22; at 3-1/2 months off Orgovyx my PSA bounced back to 0.98. My scheduled consultation with the RO is at the end of January. Should I ask if that bounce is so soon based on your comment that "PSA bounce is said to occur at 12 - 18 months out (and as far out as 2 - 3 years) ..."? When I last saw my RO, she said that a rise in PSA will be normal if it correlates (can be explained by) a corresponding rise in my T level. My libido and erection is back to pre-ADT; I don't have a pre-treatment T baseline number, so can't say if T is back as well.

Jump to this post


Replies to "@brianjarvis I was on Orgovyx starting March 26 and had my SBRT treatment in mid-April 2025...."

@vircet You can find many PCRI videos (w/Dr. Scholz, MD) on YouTube talking about this topic - what to expect with PSA following each type of radiation treatments - EBRT (SBRT, IMRT, Proton) and internal radiation (brachytherapy: HDR/LDR), and what PSA bounce is all about.
==========

At each of your PSA tests, it’s important to know what your testosterone levels were.
> At 3 months post-SBRT (PSA of 0.36); were you still on Orgovyx?
> At 6 months post-SBRT (PSA of 0.22) & 2 weeks off Orgovyx, how high had your testosterone levels risen?
==========

Typically, ADT hormone therapy will push your PSA to nearly undetectable while it’s in your system and then PSA will begin to increase as the ADT wears off. (My PSA remained at 0.008 ng/mL the entire time the ADT (Eligard) was in my system. Once the Eligard wore off, we measured my PSA at 0.198 ng/mL (as you can see in my attached PSA tracking chart). That became my nadir.)

At just 3-1/2 months off Orgovyx (PSA at 0.98), that’s too soon to for a PSA “bounce.” With Orgovyx out of your system, PSA following SBRT should remain very low (“nadir”), but begin to stabilize near your “new normal” PSA levels.

(If it were me, at that next consultation I’d request another PSA (& testosterone) test just to see if PSA is still trending up (or going down). If it’s still trending up, I’d request a PSMA PET scan to get a better view of what might be going on.)

You mentioned, “When I last saw my RO, she said that a rise in PSA will be normal if it correlates (can be explained by) a corresponding rise in my T level.” Yes, that’s true - a slight rise in PSA is normal with a rise in T level. But, that rise should optimally be capped at about 0.2 ng/mL and will be your “nadir.” Then, over time, your PSA may eventuality rise a little more and settle into a range that will be your new normal. (My “new normal” PSA is between 0.35-0.55; if it begins trending well above that range, we’ve already agreed that we’ll start looking into it.)