10 months after brachytherapy seeing a slight increase in PSA

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.)

@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.

As mentioned, you still have a prostate which produces PSA. The nadir can take up to 18 months after radiation (3 years with low dose brachytherapy). You should get below 0.5, but a large number of patients with radiation as the primary treatment never get to <.1. With RP everyone should since the prostate is gone. As you can see from Brian's chart 4 years with the PSA bouncing between 0.3 and 0.5 after the ADT was stopped. Recurrence for RP patients is defined as 0.2 PSA, but for radiation patients it is defined as 2.0 PSA so 10x as high.

@nittanylion
I have attached my psa chart, as well, as of about 1 month ago. I too, had 3+4. 10.2 PSA at its height. No ADT. Treated with 5 sessions SBRT MRI guided in 2023. Out of 5 center of excellence (trained or, at such facility) radiation oncologists I saw, only one suggested ADT, even though my PSA was above 10.

As this group said, every body is different.

@bens1
Looks like a real good result. You never hit <.1, but it stayed quite low so It doesn’t matter.

A good result after radiation. It makes one wonder why a doctor would say it will hit <.1.

Thanks, @jeffmarc

I was also happy to see @brianjarvis put up his PSA results. As we all know, there is a tendency for doctors to put us all in statistical educated guess boxes, in a number of ways, so I think it’s helpful for all of us, as patients, to see different PSA patterns or other result patterns from treatment that may help us all feel a little bit better. Our differences and results, the other variables not withstanding, is sort of a quasi standard for all of us and it’s concept may give us a little bit less stress. Every body is different and the doctors world is not perfect in its prediction capabilities.

P.C.R.I. interviewed two of the brachytherapists who are with Western Radiation Oncology in a video entitled Brachytherapy for Prostate Cancer. They only do LDR, i.e. low dose rate brachytherapy that is done with permanently implanted "seeds". They claim to do more than 1000 cases per year, 8000 to date.

At around 1 hour 20 minutes into the podcast, in a section "How do I measure results" they discuss the PSA bounce phenomenon @brianjarvis mentioned in a comment here.

They say they observe it in 20 to 30 percent of their patients. The discussion mentions a case where a post treatment PSA of 0.5 goes to 1.2 then three months later comes back down. It appears they don't observe the PSA going right back down in every case, yet they claim the main thing is if the PSA stabilizes. A typical case is said to be a full point bounce. They say their experience shows that jumping in and doing a biopsy is not indicated as the tissue can be difficult for a pathologist to classify, as it resembles cancer, but it is typically not, at this stage. They say that "for us for up to two years a biopsy for those guys is worthless".