Is this PSA expected 5 years after SBRT?

Hey @modeler , I'm not an expert but have been reading here for a year or so...

I would say that going from .5 to .61 in a years time, not really a big deal. That .1 difference could be a host of things. A little dehydrated that day, recent activity etc.. I think the more important readings will be the next couple.

I see you're plotting annual readings, my guess is you are, or at least were, getting tested more frequently, plotting those numbers might be helpful.

If it was me, and I was getting tested annually at this point, for my own piece of mind, I might ask the doc for quarterly testing for 6 mos or a year to make sure it isn't the start of a trend, other than that I wouldn't be too concerned, but, everyone is different.

Also anecdotally, I had a conversation with a friend who goes to the same urology group I do who had radiation for treatment (unfortunately I've had RP and radiation) , his PSA is in your range and went up slightly like this. Our doc told him that over the years (he's been 6) some prostate cells can regen causing a very slight uptick in the PSA. It's the first time I had heard that and I'm no doctor but perhaps is something like this.

Hopefully it's nothing. Good Luck

@web265 , Thank you for your reply. Your friend's experience is helpful for my understanding of what may be going on. This is the first bump in PSA since my SBRT, and I got a little concerned. Time will tell how it goes. My RO didn't seem to be too concerned. He told me not to jump off a bridge.

BTW, my PSA readings are spaced about 6 months apart. My next reading is about 6 mos from now.

The best to you.

I hope I can shed some light on things for you.

My brief lead up to explaining things to you:
1. PSA of 2.46 in 12/2008 and biopsy showed Gleason 8. Had radical prostectormy
2. 6 months after surgery PSA was >.05 which means it not be detected (GOOD news)
3. 3 years later it began to creep up to about 1.0 and 40 radiaitons sessions were instituted.
4. PSA 3 months later was again >.05 ( so was feeling great and felt I was "cured"
5. SIX years later 2017 my (QUARTERLY) testing showed that it was creeping up very slowly by about .02 every two months and in the fall of 2017 I had an MRI which showed NO detectable cancer cells.
6. We continued to monitor my PSA every six months and watched as it continued to VERY slowly go up---meaning that there was something growing but we still did not know where. (Prostate cancer generally goes to boney areas)
7. November 2021 a Petscan (where a dye specific for prostate cancer cells is injected and the body from neck to mid-thigh is scanned) failed to show any detectiable areas, BUT we agreed to continue to watch it. This was done when my PSA was .60.
8. In February 2022 PSA had gone to .94
9. Retest in May 2022 was .92 (yes it had gone DOWN)
10. PSA test in Sept 2022 showed it at 1.24 (up again)
11. December 2022 it was 1.94 (double the Feb 2022 test ) and another PETSccan was ordered for first week of Jan 2023.
12 Petscan showed small spot in lung, larger spot on verterbrae, and one on a rib.
13. Was started on 6 month injections of Eligard
14. At same time three sessions of SBRT were scheduled over a 5 day period
15. Was referred to a hematologist/oncologist who has found that best way to attack any minute existing cells and to any possible future spread of the cancer to cells is to add a drug to block tertosterone from reception sites on minute cancer cells --- thus with the Eligard "starving" the cancer cells that (at this point) cannot be found.. I shall begin on that drug within the next few days.

Hope this helps. YES if it is going up you should be getting check more than once a year....as I said, as soon as we saw changes I went to 3 month testing

What I remember from PCRI.org and Grand Rounds in Urology videos is that PSA bouncing around is not a concern; it's a relentless rise.

@kpgnsm, I'm beginning to realize the complexity among the different types of and treatments for PC. Hoping that the Eligard is effective for wiping out your cancer cells.

My next PSA test is in about 6 mos from now.

I have a question regarding your bullet entry at #14. Where were the 3 sessions of the SBRT targeted...prostate (or what may remain of it) or the vertebrae and the rib?

Thanks for the question.

The Petscan showed NO cancer cells in the (former ) prostate bed. The three that DID show up were in the T4 verterbrae, the 2nd rib, and the upper right lobe of the lung. I had 40 radiation treatment in 2011 that "killed off all the cancer in the prostate bed, I guess. But of course cancer cells are carried in the blood and deposited elsewhere and "like seeds in a garden" some grow and some do not. Prostate cancer cells normally head for the boney area such as the spine (vertebraes), the hip, and ribs. BUT NOT normally to the lung.

In my case evidently the T4 verterbrae, the 2nd rib, and the upper R lobe ofthe lung are (sort of adjacent to each other so we think that it started at the verterbrae and then split off to the rib and lung.

So simply the SRBT three sessions I had (since the lung and rib were "sort of" in line) was really two beams each time ....one aimed at the verterbrae, and the other hit both the rib and the lung at the same time.

Hope I answered your question. If not please get back to me. I saw my hematologist today and as soon as it is approved by insurance I will start on the Erleada androgen terstosterone blocking (at the receptor sites of cancer cells) drug.

Well current thought by the top cancer docs is to
1. Radiate known sites
2. Use the Eligard / Lupron injections to keep (still undectable cancer cells in the body from) getting growing
3, Using the Erleada / Zolodex / Xtandi class of drugs to block the receptor sites so tertosterone (the fuel for cancer to grow) cannot get to the cells thus sort of starving them so they cannot grow any more or spread.

Let me know if this helps. I should add that until about 2018 (according to my hematologist/oncologist standard therapy would be to just radiate and add the Eligard / Lupron 6 month shots, but then they realized that it did not totally stop the tertoserone from fueling cells so they started adding the Erleada class of drugs to block the receptor site and thus starving the cells even more. The goal really is to reduce the tertosterone in the body to as close to NONE as possible---but down size is that the drugs make you more tired (when walking or exercising {and I walk 9 miles a day} and supposedly they weaken bones [leading to possible breaks] and other things but everyone is different. I have to say that getting a little tired 5 miles into a walk is the ONLY adverse effect I had.

@kpgnsm, that course of action makes sense to me. I had my SBRT in 2017. It did not include any follow-up with hormone drugs.

Hello,
Thanks for sharing your story. I had RALP a year ago. I’ve been getting my PSA level tested every three months. Per surgery, my PSA was 4.2 and afterwards it has been 0.05. After reading all these blogs, I’m even more aware now of the need to keep watching my PSA trend. I guess you’re never totally out of the woods. It’s certainly varies from person to person. Good luck with your continuing recovery.