PSA fluctuating during ADT treatment and after Radiation: Concerned

Welcome @als. Seeing your PSA fluctuate during treatment is nerve-wracking to say the least. Here are a couple of helpful related discussions that I encourage you to review:

– Rising PSA's after treatment – an answer https://connect.mayoclinic.org/discussion/rising-psas-after-treatment-an-answer/
- Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

Fellow members like @jonbuuck @jogger01 @bruto1 @mrbill @jap57 @sanway have also had treatment with ADT and radiation and can offer their experiences.

Als, was your PSA retested to confirm the lab results?

I have a lot less experience and knowledge than a few of the veterans around here, but, just a couple quick thoughts.

Is it the same lab and same test code? I've had it happen where I go to the same lab and they use different sensitivity tests. Make sure it's an apples to apples comparison.

Secondly, my "team" all tell me that rising psa always has to be watched but when you in the very low numbers like you are, how fast it multiplies is not as concerning as it would be in the higher number levels.

and as @colleenyoung suggests, a repeat of the test may be a good idea as well.

Best of Luck to you.

Thanks for your valuable comments, today I met the oncologist who explained that since the variable reading is very low, there will be no matter to worry, unless the psa elevates to more than 0.5 ng/ml.

Regards,
als

als, I will share my case experience for reference. 2018 diagnosis with prostate cancer. January 2019 prostatectomy surgery. Three months after surgery, PSA undetectable. However, at 6 months post surgery the PSA started rising .11, .13, .14…..Mayo has excellent imaging capability to help identify areas of prostate cancer recurrence, even at very low PSA levels….Doctors initiate 18 month regiment of Lupron to suppress the cancer, plus then initiating radiation ~6 weeks. What helped keep side effects manageable, I tried to keep physically active, walking, jogging, weights…..just had a PSA test Friday, and all still good now. Best of luck. If your care team is Mayo, you are with the best.

Very interested news, I wish you excellent health.

Hi all.
On ADT for 2 months prior to radiation treatment. PSA was reducing down to 4+ Started EBRT and PSA reversed downward trend and rose to 6+. Only 9 sessions in of total of 28 goal. Is the rise normal during treatment? Anyone have experience with this? After treatment how long does it take for PSA to go down again (continuing on ADT)?
Thank you all and God Bless.

@jaykwik, I wanted to check in. How are you doing post radiation?

Thank you for checking. Doing well. Some fatigue but very manageable. The reverse in PSA decline was temporary and was partly due to different lab and possible due to some swelling. Radiation now complete and PSA is .2 Still on Firmagon. This is 6 months of ADT. They suggest 6-12 mos. Very grateful and blessed. Doc suggested Prosteon (supplement to offset any bone loss during ADT).

Not sufficient information to respond . e.g. It may be a temporary "PSA Bounce after 2 to 3 years following radiation " which is normal .

You ask "Is it a matter of concern..."

NO!

There are a lot of factors that go into PSA results as others have said:

The lab - which assay they use, calibration of their equipment...
Your pre-lab routine

Attached is my clinical history. When my medical team switched from the traditional single decimal point to the USPA, two decimal point, there were variations as you can see in my clinical history (attached).

So, what you are looking for is multiple PSA tests, spaced some time apart, that show a continuous and upward trend. What that time interval is for spacing of the labs is something to discuss with your medical team. For me and mine, it was 2-4 months, three or more tests and a PSA between .5-1, giving us an almost 2/3 chance of imaging locating where the PCa was, thus informing the treatment decision.

The switch from the standard PSA to USPA has been a blessing and a curse. It brings prostate specific anxiety to a new level where every "change" is scrutinized by us, the patient for significance. Keep in mind, even if the change in PSA is indicative of a return, there are other clinical factors in play:

Gleason Score
Grade Group
PSADT
PSAV
Imaging.

Also, if you were on the standard test, which many still do, your results would be < .1 and you and your medical team would be spending the consult time talking about other things, vacations, best places to dine out, the concert you went to, kids...

Relax..

Kevin