First PSA test after radiation for intact prostate?

Mine was done at three months, and then every three months since, except now my last result was extremely low so I've been moved to every six months.

The explanation given to me with radiation is that they look for the trend--three upwards moves of PSA in a row *OR* PSA hitting 2.0 more than the lowest point (for example, if the lowest PSA you get is 1, then a 3 would be cause for concern).

Generally, after radiation, PSA will drop slowly so don't be alarmed by the first post-radiation test. Mine was .4 if I remember correctly, but three months later it was .1 and then three months after that .04 which is when I got put on six month monitoring.

Our first PSA test (post-radiation) results are comparable. On July 7 , two and a half months after SBRT, my PSA was 0.36 (0.4 rounded).

I asked my RO what he expected my first post SBRT PSA to be.....he said "lower". The first PSA is rather meaningless. It can take up to 24 months for the PSA to reach a nadir. (lowest value). And some research shows a longer time to nadir as having being a prognostic plus. As beammeup said, and the definition of BCR is, a PSA of 2.0 above your nadir.
It is a long ride. It is a trying, worrying ride. It can literally be a "bouncy" ride. But we have to be patient, see where we are, and where we are going on that ride.

Stay Strong Brother, We Got This.

Pre-treatment PSA 7.8. SBRT completed 12/28/2023
3/28/2024 0.09 (While still on Orgovyx)
6/28/2024 0.19 ( Three weeks post-Orgovyx)
10/17/2024 0.59
1/8/2025 0.62
3/20/2025 0.65
5/21/2025 0.47

Be aware that while your PSA may continue to drop, it can take years for some people to get to their minimum. Don’t be worried if it doesn’t drop fast enough, as long as it doesn’t rise multiple times you are doing fine.

I told my medical oncologist that I wanted to avoid any anxiety as to how my proton radiation & ADT (Eligard) were working. So, we scheduled my first post-proton radiation treatment PSA/testosterone test for the day after treatments ended.

This was our pre-planned schedule of my PSA/testosterone tests:
> before the 1st ADT injection
> after the end of proton radiation
> 6 weeks later (before the 2nd ADT injection)
> 3 month intervals for the next 2 years
> 4 month intervals for the next 2 years
> 6 month intervals for the next 2 years (this is where I am now)

That schedule was really clever. I should have done that.

Tks all. I went through the PSA anxiety for years before the cancer appeared. Now I get to do it again..

The comments here are helpful in that regard, very helpful.

Ironically, the cancer showed up after my PSA had been stable for some time, and urology had lengthened the interval between tests. An outside doc did a PSA test without telling me first, half way through the interval, and that discovered the cancer. So thanks for that!

BTW, I am not on ADT (long story). That should lead to initially higher PSA than if I was.

Tks to all for the helpful comments!

@rotate
R/Os will usually give you their plan for doing PSA test after radiation.

What I got was every 3 months for first year looking for rising in PSA level. Please talk to your urologist and or R/O about what you should expect.

What I was told by my R/O and PCP was they wait 3 months after radiation ends to allow prostate to calm down. It has gone through WWIII and takes some time to come down from the battle.

Your urologist or R/O should have told you that it usually takes about 2 years for the PSA to go to it's lowest level based on statistics. They should have also told you that to expect bumps in those PSA test. I bump upward does not mean your cancer is active again it is common and that is why they told me.

I went from 3.75 PSA prior to radiation to .10 2 years after radiation was completed. I had PSA test every 3 months and only one time did it bump up. Even though I was told to expect it and normal I called and was reassured common and the goal of the PSA test was to look for sustained increases in PSA levels.

When you will reach your bottom it based on your prostate not someone elses. I just had my PSA test done and my Mayo PCP said to me that once PSA levels goes below .10 (mine) it is then determined to be undetectable. Now I know other posters will tell you different numbers so I am only passing on what my Mayo PCP stated our Mayo Jacksonville lab uses for undetectable.

Thanks for all the detail.

R/O @ Mayo PHX told me they would follow starting 3 months after the proton beam treatment. But I just found an appointment for it just over 2 months after - haven't had a chance to talk with them yet but will call tomorrow. I did not get any more info on the PSA following from the R/O.

I got no notice of the upcoming appointment - it just appeared in the portal - one for a blood test, one for a followup with a PA. I found it because I did get an email about a new financial estimate, and that got me looking.

Weird that the IT system didn't notify me of new appointments, one of which is just 2 1/2 weeks out (conflicting with another unrelated Mayo appt).

@rotate, that is odd that you did not get a notification for your upcoming appointment. Please check your spam folder to make sure it didn't go there erroneously. Please let the scheduler know a) that you did not get a notification and b) that there is a conflict with another Mayo appointment. They should be able to help get that fixed so that you can be sure to be notified in the future and to untangle the double-booked appointments.

If I understand this correctly:
Your nadir while still on Orgovyx was 0.09
Three weeks post-Orgovyx it was 0.19 (I suspect at this point, Orgovyx has not yet been totally flushed out of your system)In the 4th, 7th, and 10th month (approximately), with the med totally out of your system, your average PSA was in the low 0.60s, no doublingIn the 12th month post-Orgovyx, PSA was trending down to under 0.50
Regardless of what your actual nadir was, you're far from seeing a rise of 2.0 above nadir.
Even if you did not reach yet the ideal nadir of < 0.2, I think you are all good. If I can somewhat duplicate your experience, I will be so happy.
Congratulations. (Do update us as your PSA trends down closer to 0.2