Rise psa? After radiation

Going through the same thing on a much shorter timeframe. Gleason 9; stage IVb - cM1. Radiation OCT 2025. PSA after radiation 0.23, March 2026 - 8.80; April 2026 - 10.3. PSA doubling time - 3 weeks.

What comes next:
PSMA PET scan, genomic testing, focal radiation on what they can target, systemic treatment on what they can't (ADT, Chemo, etc.), genetic targeting if appropriate.

I'm at the focal part - SBRT on an L5 bone metastasis. Chemo discussions next month. Best wishes!

How often have you gotten PSA tests? With RT+ADT the official BCR is a PSA of 2.0 + nadir so about 2.2 for you. There can be a lot of noise in PSA tests. Unless you show a steady rise, not much to do except more PSA tests. The probability of actually having a recurrence is > 50% once PSA goes above 1.0.
After radiation salvage treatments include SBRT or Cyro ablation depending on where the lesion occurs. If you have symptoms in addition to the PSA increase, you may be able to get treatment sooner.

Thanks a lot
Biochemical recurrence (BCR) or Clinical recurrence?

One more thing...no matter what the numbers are, your PSA is going in the wrong direction. I would not wait a year between tests.

@boki01 Biochemical recurrence since they are depending on the PSA to signal the recurrence. Clinical is when they do a PSMA Pet scan, etc. and find cancer. Also, as mentioned you want to get PSA tests every 3-6 months and have these tests done at the same lab to get a record of a continuous rising PSA vs. artifacts from different labs/measurement methods, possible inflammation, or a PSA bounce (know artifact after RT), etc. all of which can produce a higher PSA but do not cause sustained increases over multiple tests.

Don’t forget that since you had radiation as primary treatment, you still have a healthy prostate remaining (though about 35% smaller than before).

Unlike those who had a prostatectomy - who have an expectation of undetectable PSA for the rest of their lives - your remaining prostate gland will continue to naturally produce PSA - though at “new normal” levels - for the rest of your life.

For you, a PSA of 0.(anything) ng/mL is good.

As for what to expect next? —> continue with regular PSA tests. If your PSA goes beyond 1.0 ng/mL, then start looking into it. (I’m 5-years post radiation; I have PSA tests every 6 months. My most recent PSA test was 0.314 ng/mL. See my attached PSA tracking chart.)

Every body is different and every nadir is different. I have attached my PSA history.

If my PSA rose for two consecutive blood tests, after being tested every 3 months, I would get a PSE test from Oxford Biodynamics to see if there was a re-occurrence (they claim 94% accuracy). My RO has already told me that if my PSA went up 1 point (as opposed to 2), she would get a PSMA Pet Scan for me. At this moment, I understand there are heat, cold and electrical treatments, if I have a re-occurrence. I am personally not convinced that any one of those is better than another but am keeping an open mind.

I had no ADT and an MRI real time guided SBRT and finished my 5 treatments in February 2023.

@brianjarvis
Good comments by Brian, you still have live PSA tissue which will generate a PSA reading. In future tests hopefully the readings will become more consistent with a little bounce up and down. But if several tests start to show a definite incline upwards I’m sure your doctor team with discuss it.
Dave 3+4

@clevelandguy You’re correct - we’ve already discussed that if I show three significant (unexplained) PSA increases in a row, we’ll look into it. So far there’s only been minor variation from test to test.