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PSA rising fast after SBRT
I am 65, Gleason 4+3, localized 2 tumors. PSA 6.7; Had SBRT (4 sessions, 9.5 gray each) in early August 2024. Minimal GI and GU side effects; took 4 month Orgovyx. In 11/24 I had first psa test, result was < .01, testosterones was 13. 2/25 test shown psa rose to 0.4 and testosterone level rose to 384; 5/25 psa rose to 0.8 and testosterone rose to 521. Should I be worried with the rapid increase of PSA level and testosterone? I am taking 5mg cialis after the radiation to treat BPH, i.e frequent urination at night. I have noticed sexual drive was stronger than pre-treatment . No ED. My testosterone level is also higher than pre-radiation treatment. 521 vs. 390. I believe this has to do with cialis.
Does anyone have similar experiences?
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Not a physician, but a rise in your PSA when coming off Orgovyx is not at all unexpected. I was 68, 4+3, localized. Had 5 fractions of SBRT at 7.25 Gy with a focal boost to the lesion at 40 Gy. While your nadir is 0.01, that is an artificially low value because of the ADT. Nadir plus 2.0 is a sign of biochemical recurrence.Your PSA is going to bounce around for a while. And in fact, a PSA "bounce" is seen as a positive, not a negative sign.
Here is my PSA history, and my RO and Uro think my numbers look great.
Pre-treatment PSA 7.8
SBRT Completed 12/28/2023
Orgovyx Completed 06/05/2024
DATE PSA
3/28/2024 0.09
6/28/2024 0.19
10/17/2024 0.59
1/8/2025 0.62
3/20/2025 0.65
Keep track of your PSA every 3 - 4 months. I suspect you are right on course.
Stay Strong Brother. We Got This.
At that time, from 6/28/2024 to 10/17/2024, was PSA doubling time not (never) a concern? I guess that even if it was, there was no doubling from 10/17/2024 to 3/20/2025, and indeed your numbers look great!
The 6/28 value was still suppressed from the Orgovyx having been 3 weeks earlier.
The rule for people that have SBRT treatment is you start treatment when your PSA hits 2 above the minimum it has hit. With a first test of .01, then you need something more done when your PSA hits 2.02. As has been mentioned, it may just be bouncing around, which can happen.
In 11/2024, the Orgovyx was clearly still in your system so, except for being certain that Orgovyx was doing what it was supposed to do (based on your testosterone and PSA levels), I wouldn’t read much else in those numbers.
In 2/2025, with the Orgovyx out of your system, your PSA was returning to your new normal levels (anything < 0.50 immediately after treatment is good). The rise in testosterone is normal, and is exactly what should happen.
The rise in PSA to 0.8 on 5/25 is concerning. Sometimes with SBRT there is a PSA bump (or bounce), but that’s not typically until 12-18 months out. (If it were me, I’d get another PSA test in June, just to see if the 0.8 was a fluke, or if it’s still trending up.)
Prior to treatment, what were the results of your PSMA PET scan?
With BPH, what is the size of your prostate now? What is your PSA Density? If your prostate is still large, a PSA of 0.8 might be normal. (Larger prostates typically produce more PSA.)
Are you taking cialis for BPH or ED? (When I had frequent urination pre-treatment, they had me on Tamsulosin (Flomax) and then Finasteride.)
(At 65y, I had PSA of 7.976, Gleason 4+3=7, localized, 2 tumors. Had 28 sessions of proton radiation, 2.5 grays each during April-May 2021. No GU, GI, or ED side-effects; had 6 months of Eligard. PSA dropped to 0:008 during treatments; most recent PSA was 0.476.)