First PSA 1 month post-Proton Therapy higher than I would like

Posted by mcan56 @mcan56, Mar 4 11:45am

So, status update and gut check. I completed 5 sessions of high-dose Proton therapy at OU Stephenson on February 9. It took a few missed sessions due to the finicky nature of the machine, but once we got started rolling it was a Tuesday, then the next M/W/F and then next M.

I didn't start having any side effects until Wednesday afternoon, after the 3rd treatment and it was urinary pain. I'm still using AZO twice daily, but I think I am close to not needing any longer. The rectal issues started later that 2nd week and included mucous discharge, then due to quite a bit of straining at times, rectal bleeding that was remotely diagnosed as proctitis (I do have a Barigel spacer). This is very much complicated by Iron supplements and Mounjaro, so it was hard (for me) to determine what was "normal/expected" as I had some bowel issues prior. (thick/sticky stool, less frequent stools, some straining- used 200mg Colase daily prior to treatment.)

Ultimately this is "better" now, no real bleeding issues, I try to just not strain and let things happen, it's just frustrating feeling like I need to BM at times but not being able to.

So, in general, I feel like my symptoms are in the normal range. BUT. I just had my first PSA yesterday, in advance of checkups with Oncology Urologist and Radiation Oncologist tomorrow, and it dropped to 3.3 from 11.7 pre-treatment. I know radiation PSA levels take some time to drop versus prostatectomy, but 3.3 feels high. Anyone else have experience with PSA levels 1 month after treatment?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Jeff Marchi | @jeffmarc | Mar 4 12:57pm

Not a time to worry. I know of people that took 3 years before their PSA hit the low point. It is way too early to consider this to be too high. Get a couple of more PSA tests over the next six months to see what’s really going on.

If you are on ADT, you should be able to get it down to much lower numbers in the next month or two. Make sure to have your testosterone level checked if you are on ADT to make sure it is below 20.

brianjarvis | @brianjarvis | Mar 8 9:12am

Your experience with proton radiation & PSA results without the use of ADT is probably normal (or at least expected). (I had 6 months of ADT with my proton radiation treatments; my PSA profile - see my attached PSA chart - shows a quicker drop, and then maintains a low PSA level since then.)

Regarding the rectal issues —> It’s quoted that the gel rectal spacers reduce radiation to the rectum by 70%. That’s fine with standard radiation, but with SBRT, that’s still a lot of radiation hitting the rectal tissue each session.

The urinary bother you experienced is common with proton SBRT (due to the high dose each session). Dr. Rossi talks about this during his portion of this 2023 Mid-Year PCRI conference starting at about timestamp 4:30:45: https://www.youtube.com/live/WTqPnSRYtW4

mcan56 | @mcan56 | Mar 9 9:11am

Thanks guys! Sometimes it is therapeutic just to come type out my worries. I try not to let people around me worry, so I probably don't let on how much it does worry me at times. I also do try to just remain optimistic.

In any case, my follow-ups were Thursday, first with the Nurse Practitioner for my Radiation Oncologist. He said an 8 point drop was amazing and pretty clear indicator that they got it all. He said we will do another PSA in 3 months and see where it is at. We discussed the side effects, and we agreed that it was all pretty much within expected norms and honestly, if this was the worst of it, I'm pretty happy.

Next I spoke with a resident for the Urology Oncologist (and then the doctor) and he also said that an 8 point drop was excellent and that it wouldn't have been unusual for it to have gone up briefly before dropping. He said we will just monitor every 6 months with PSA and when it is within a few tenths back to back, we will set that as the new baseline. Just as a general guide, they then add 2 to that, and that would be the trigger point for deeper investigation like MRI.

I am not on ADT, so my labs also showed my testosterone was 331 ng/dL- I've never been happier to be at the low end of normal!

bandit11 | @bandit11 | Mar 9 7:10pm

My first PSA post proton radiation was 2.7, down from 8.8. Then around six months later it spiked to around 5 or so. It has continued to decline and now almost four years later it is .27 . ADT was not part of my treatment.