Rising psa 15 years after radiation: Is cancer back?

Depending on the type of radiation therapy, some of your prostate might have survived and be producing its own normal PSA (unlike after a prostatectomy, where *any* PSA rise likely points to renewed cancer activity from cells that had previously escaped the prostate). Regardless, the PSMA PET scan sounds like a wise next step, and maybe gene testing as well. Best of luck!

After having radiation hitting a PSA of 2 is pretty high, unless it’s a Reoccurrence. You are getting a PSMA pet scan? There are a few different pet scans.

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@sharlee
No it does not mean your cancer is back. This does not come from my opinion but my Mayo urologist, and R/OS at Mayo and UFHPTI.

Just like before you had prostate cancer diagnosis many things can make your PSA rise. BPH, irritations, infections, etc.

Regarding cancer. Most radiation treatments are not designed to kill prosate cancer. What is done is it damages the prostate cancer cells and they cannot reproduce. Unlike regular prostate cells when damage they can reproduce. This was explained to me by R/Os at Mayo and UFHPTI. There are some radiation treatments done to actually kill the cells but most radiation treatments are done to damage the cell reproduction ability of prostate cancer.

What has your PSA levels been? Have they been rising every time you get a PSA? How long did it take to get to 2. How ofter where you getting PSA test done?

Looks like you are seeing a urologist and thus asked him your questions. He/she is your best source of answers to your questions as he is familiar with your prior cancer diagnoses and treatment you received. His/her suggestion for a PSMA is good as can detect cancer cells.

A 2 is still below the norm level of PSA (below 4). Are you having any BPH symptoms?

My R/Os at UFHPTI said their goal was to have my PSA below 1. So far I am below that almost 2 years later. However BPH and many other things can cause PSA to rise and many others. Think optimistic.

When you had your radiation done did they radiate all your prostate? Why do I asked? My R/Os stated to me they radiation all the prostate and margins not just the areas identified by biopsies. Why? Because almost impossible to do a biopsy of all prostate tissues. Thus you urologist doing biospsied could miss areas that have prostate cancer cells. It is normal to do margin for this reason also.

Even if you have a RP surgery does not mean there were not prostate cancer cells in other areas. It is that PSA number that rises steadily that needs addressing. You are seeing a urologist and looks like he/she is looking to see if any signs of the cancer are there. Just cross fingers and hope that it is BPH, infection, irritation and you can easily treat it.
Good luck on your PSMA.

Agree with you, JC, about the timing of the rise: when did it begin and how long did it take to get to 2.0?
If it inched up slowly over 15 yrs, it’s probably normal tissue. But if it has risen quickly over a much shorter time period then it is probably malignant tissue.
This was told to me by my urologist/surgeon.
Also, a PSE test - which is new and many urologists are unaware of - can give you a 94% chance of knowing whether it’s cancer or not.
Phil

@heavyphil
Agree Phil.
I am unfamiliar with the PSE. It sounds like a new and more precise test to determine if prostate cancer cells are outside of prostate. How new is it?

My R/O a UFHPTI wanted a PSMA done prior to final treatments plan. When I had my original consultation with Mayo they did not mention the PSMA to me just wanted Decipher and bone scan done.

I wonder if doing both a bone scan and a PSE is needed? Would a PSE show prostate cancer in bones and thus not need a bone scan? I will ask my R/O and PCP this as I am curious.

Yes, JC, it’s fairly new but supposedly it is 94% accurate for detection of cancer - even if you’ve already been treated for PCa. Think it’s made by EpiSwitch?

@bens1 has all the info - check out his posts and you’ll get the name of the company and the contact person.
Phil

PSE is a patented technique that combines PSA with an extra epigenetic test, so far mainly for routine screening of people who *haven't* been diagnosed with prostate cancer yet.

It's still the same old PSA test at the core, but the company that promotes it has shown evidence that adding some epigenetic tests reduces the number of false positives for screening the general population (e.g. people who haven't been diagnosed with prostate cancer) — in other words, if someone comes back with a borderline PSA result, the "E" part (epigenetic) might be able to rule out the need for an MRI and biopsy, at least at that time.

They've claimed it's helpful in other situations as well, but I don't know if they've published any peer-reviewed studies to back that up yet.

I think @bens1 contact person said that it can be used in salvage cases as well, but again, that’s a company rep touting his product.
Would love to see an actual study but the results would probably be a few years off anyway.

Probably. Depends on what your nadir was following radiation,
The technical definition of biochemical recurrence following radiation (according to the Phoenix Criteria) is a PSA increase of 2.0 ng/mL above nadir (even though biochemical recurrence can occur before that level of PSA is reached).
Just as you did pre-treatment, you’ll have to rule out other possible reasons for a PSA increase (but, I assume that you’re already aware of those and taking appropriate precautions).
Yes, a PSMA PET scan is the next step to find out what’s actually going on.
Just take this a step-at-a-time, and don’t get ahead of yourself with concern. You’ll be fine.