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10 months after brachytherapy seeing a slight increase in PSA
I had brachytherapy in July of 2025 when my Gleason went for 6 to 7 (3+4) and PSA rose to 10. Since then I've been getting PSA checked every three months and in March of this year it had dropped to 0.331. My last PSA showed an increase to 0.407. Is this any cause for concern? I have an appointment with the urologist next week and he was upset that I did not originally do brachy, radiation and ADT even though three oncologists told me this would have been overkill.
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You really need to wait for a few more tests to see what the PSA will do. It could be insignificant it could be signs that it’s starting to come back again, but it may just go back down.
Gleason 3+4 is usually very slow growing. Were there any other aggressive issues in your biopsy that you didn’t mention? If not, then this rise may mean very little. What is important is your doubling time not just a single result.
Remember that you still have a prostate that is naturally producing PSA, but now at a low “new normal” level. PSA is going to vary. (Mine did that, too; see my attached post-treatment PSA tracking chart.) Keep tracking your PSA.
Also note that with brachytherapy (& with SBRT) they say there can be a PSA “bump” (or “bounce”) that can occur 12-18 months post-treatment. It’s important to monitor it, and not jump in and treat it out of too much concern.
It’s important not to overtreat it, just as it’s important not to undertreat it. You probably did a lot of research on your treatment options. Do you feel that you treated it appropriately based on your numbers?
(When my Gleason rose from 6 to 7, and my PSA increased to almost 8, I had 28 sessions of proton radiation plus 6 months of hormone therapy.)
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1 Reaction@jeffmarc The docs told me should steadily decrease down to <.1 but I am aware of the possibility of a bounce. I was at Gleason 6 for 10 years and then it went to 7 with a slowly increasing PSA. I had always told myself that if it ever did jump to a 7 I'd do something about it. Decipher said it was slow growing and brachy alone should suffice. Same as the oncologists said.
@brianjarvis I'm aware of the possibility of bounce with brachytherapy. Definitely not going to do any more treatment unless it becomes a real trend. I definitely feel that I did my homework - attended cancer center run seminars and spoke with three different oncologists that said doing all possible modalities would be overkill. I chose brachy over radiation because I did not want the 5 1/2 weeks of daily hospital runs. Had some nasty side effects after brachy but those have gone away. Charts are all on the hospital health site. Thanks
@nittanylion
I don’t know if any doctor can definitively say that the PSA is going to drop to <.1 after radiation. Everybody’s different not everybody has it drop to undetectable.