Xtreme PSA bounces after radiation cancer or inflammation?

PSA after radiation: https://youtu.be/zQktPZ6U80s

With your 3+4, did your MRI or biopsy show any other risk factors?

Post-radiation, the PSA trend should always be downward.

As stated above, you are always looking for a downward trend in PSA after radiation, but PSA bounce is a real thing (see video Brian posted). You seem very calm. When my PSA bounces around like that, I reach for the single malt, not a cold beer. 😁

Let us know what oncology has to say next week. Best wishes.

Neil,
Radiation continues to kill cancer cells for some time after treatments ends. Your 2.8ng/mL bounce is only a little high and PSA is only a small part of the picture. You should be headed for the post PSMA which will tell you where the antigen is located. PSMA PET is PSA specific and alone can't discern the difference between macrophages and endothelial cells in inflamed tissue and cancer. (This being a caution against false positives, which can be alarming. )
You might ask your doctor for a PSE. Along with the PSA it can help determine if you still have cancer or just afterglow. https://www.94percent.com/
If you were on ADT it could mask the PSA cue. (Another caution against possible alarm caused by comparing your PSA bounce to those who are on ADT).
My unqualified guess is that your treatment is going well.

@brianjarvis cancer was contained, low dechiper, no cribriform. Was on AS with three biopsies over 3 years. 3+4 , less than 5% 4 in 2 cores. The rate of change both up and down is more than I have seen. I can accept I am not cured but the rate of change seems unusual.

Since you didn’t have a prostatectomy, you really don’t know what your real Gleason score was. Many people with 3+4 end up with much higher after surgery. Mine was 4+3 but I know Quite a few people that were 4+5 after surgery.

Your PSA rise is not a bounce. It is a significant increase. You are right you need a PSMA PET scan to find out where there might be metastasis sprouting up.

If you had proton radiation to the prostate, then it is essentially melted. Your PSA should have been going down pretty steadily, Though some people have had it take up to three years before it hit the minimum Yours doesn’t seem to be going down to reasonable numbers, Instead, it has been too high To consider the treatment effective.

I need to discuss this with your doctor. What’s happening is not normal for somebody that’s had proton radiation..

@neilmartin Similar to mine. During the nearly 9 years that I was on active surveillance (with a 3+3), my PSA bounced around in an upward trajectory (see my attached PSA tracking chart).

Ultimately (when a 3+4 showed up), I decided on 28 sessions of proton beam radiation and SpaceOAR Hydrogel.

However, prior to starting treatments, a 2nd opinion upgraded the 7(3+4) to a 7(4+3).

Again, understanding that a Gleason score is a specialist’s educated, experienced opinion of what is seen in the biopsies tissues under a microscope - there was no way to know which one was “right.”

So, I made a commitment prior to the 2nd opinion:
> if the 2nd opinion came back a lower 6(3+3), I would still get treated to the current 7(3+4).
> if the 2nd opinion came back the same 7(3+4), I would get treated to the 7(3+4).
> if the 2nd opinion came back a higher 7(4+3), I would get treated to the higher 7(4+3).

As it turned out, the 2nd opinion came back a higher 7(4+3). So, we simply added 6 months (two 3-month injections) of Eligard to the treatment plan.

These days, PSA fluctuates between 0.3 - 0.5.

Thanks @jeffmarc .

Comments from my ONC after 9.6 spike, subsequent to 9.6 it dropped to 3.8. "I think your judgment is sound; it's reasonable to be worried. Your PSA is not where I expected it to be. The reason for waiting is not that I'm convinced you're in the clear, but that I think it's the best next step to gather more information/data to help us figure out what's going on.
PSA "bounces" are defined as a post-radiation increase, and yes those are usually of smaller magnitude. PSA "spikes" on the other hand are exactly this magnitude and usually related to prostatitis, UTI, sexual activity, or someone else similar. I'm hoping that is all this is". Now we are at 6.4 nearly doubling the 3.8 so I think the spike theory might be wrong. In my mind this will be quite aggressive cancer or the spike of the century. Urologist gave me similar feedback. If they are off base with their judgements its a real disappointment as I am at a center of excellence. With Dechiper, .30 Color Genetic, low Gleason score this should have been killing an ant with a hammer as they say and my team suggested. Sigh

@neilmartin Very frustrating indeed…all your parameters portend smooth sailing so something is definitely up.
Couldn’t hurt to have another PET but if it is negative what then?
Perhaps a month on Orgovyx would be the best diagnostic thing you can do.
If your PSA plunges to almost zero, then you know for sure you still have active PCa…if not, then perhaps it is one of the easier fixes like UTI, etc..,
I would, however, try to avoid a Lupron shot since it might just make you more miserable; if the Orgovyx affects you adversely you can always stop it. Best,
Phil

@neilmartin This is where we have to be careful with one specialist’s opinion (even at Centers of Excellence) unless they can show data to back it up. (I always asked my Uro, RO, and MO to “show me” or “where can I find that?” so that I could look it up for myself. Not that I didn’t believe them, but if something is going to happen to me - possibly something bad - I want to have buy-in first.)

What one doctor might call “the spike of the century,” this doctor at a PCRI conference a few years ago said that “…the typical bounce is in the 1, to 2, 3 range.” Then he goes on to say that “I have had patients at 10; I had one guy at 16 and didn’t treat them. They didn’t want to go with treatment and waited, and their PSA went away.”

See that PCRI Conference interview at: https://youtu.be/ogDhQv-1Axo (starting at about the 6:00 minute mark). The full interview is less than 8 minutes so, you might want to watch the whole thing just to have context.

I bookmarked that interview a couple of years ago because when I heard him say PSA bounces to “10….16” that seemed so far beyond everything that I had heard/read elsewhere.
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My personal view is that doctors aren’t gods - they’re just people like you and me. They’re working in an occupation for which they have an aptitude and great passion for (and I respect them for that); but, they’re not perfect; they’re human, with human frailties; they sometimes make errors. (No different than you and I who were very good in our individual careers and the teams we worked with, but we weren’t perfect.)

So, they’re not always right; no one doctor knows everything; they only know as much as they’ve learned and experienced. Whatever they tell me, I accept it with some cautious and informed skepticism (and optimism).

(Ok..,,off my soapbox.)

@brianjarvis and heavyphil,

Thank you for your insights and efforts on this topic. You make this group very valuable. Hopefully as I transition through this I can add to body of knowledge for the rest of the group. I will post again here as things unfold.