Rising psa 15 years after radiation: Is cancer back?

@ray311f503 Thanks, hoping for you best outcome.

Well, more clinical data may be useful in providing our assessment.

I've provided this link, posting again so you can listen if you want - https://ancan.org/playing-the-long-game-does-your-recurrent-advanced-prostate-cancer-need-treating-nci-seminar/

The takeaway for me is not all BCRs need to be treated,,,,

There are many clinical data points that go into any treatment decision:
GS
GG
Genomic Testing
Other Testing - Decipher...
Imaging
Co-Morbidities - diabetes, blood pressure, kidney, cholesterol, cardio vascular.
Age and Life Expectancy

There is one this article points out, PSADT, PSAV...mine is very rapid, less than four months. So, we treat early, If the PSADT is say greater than 12, well, may be no action required other than discussing with your medical team the frequency of labs, imaging and consults.

Another discussion with your medical team may be at what PSA do you treat? In my 12 years, I have seen answers as high as 10, some say 2, others like me, between ,5-1 (keeping in mind my clinical data).

As to imaging, yes, if MDT only is the treatment options you and =your medical team are considering, having something go shoot at is helpful. Intuitively and the data says that the higher one's PSA, the greater the statistical probability imaging shows where the activity is. < .5 1/3, >.5-1 a 2/3... Still, there are limits to its detection capabilities, metastases, micro, too small to be seen. Then there are other factors, some data points to the PSADT as a factor, higher then more "detectable, lower, less likely (may have to do with the activity level of the cells).or some PCa is not PSMA avid so you have to use a different scan such as the Aximun (sp?)..The data from clinical trials finding its way into mainstream clinical practice is MDT may delay the need for systemic therapy. However, you can choose to add systemic therapy to MDT, 6-12 months generally, What is the tradeoff in greater PFS and RPFS of doing so, some, only you can answer is it worth the gain.

There are other treatment courses of action if systemic therapy is in play - ARI monotherapy, the PATCH Trial...

Were I you, what would I do?

Like I said, I don't know your clinical data so I would not jump into any treatment decision until I had imaging results. I would assess all the clinical data, then decide if, when, how and duration.

Kevin

@ray311f503
Similiar treatment. 30 rounds of proton no hormone. I had my PC treatment in 2023. I like you have had PSA done every 3 months. I was told by my UFHPTI R/O the goal was to keep my PSA below 1.

I have had the bounces on my PSA but minor ones like .10 to .12

Did you have BPH prior to your treatments? If so can cause your PSA to be higher than even yours is.

I assume from your post you are at the 14 month mark. What was your PSA before the one you quoted at 2. Was it close to 2? If so yes bumping will occur and will take for most to get their lowest PSA reading 2-3 years after treatments end.

If you are only 14 months out your prostate is still recovering from WWIII. And if you had BPH prior more likely you will have now also.

The above comes from my personal experience with this and my R/Os as Mayo and UFHPTI as well as my Mayo PCP.

Yes 14 months. My PSA after 3 months of radiations went from 1 up to 2 in 14 months. Yes I had BPH and was already taking Tamsulosin for it. I was listening to a doctor who was saying the same thing about a bounce that can bring the PSA up to 2 and 4 and come down after 2 years, interesting. My oncologist was not recommending Hormones yet. My brother in law was going through the same at Christmas time with Lupron and is feeling the effects pretty much muscle wise. Thanks for replying.

Proton radiation in 2010..mornings for 2.5 months of low dose proton radiation therapy. Previous diagnosis with biopsy at Gleason 3 plus 3, PSA: 6.47 T1B. Slow-growing prostate cancer.

Flash forward to the current some 15 years later and PSA is beginning to increase. PET scan and MRI show nothing...Zero cancer. Therefore, what is the "why"! Aging process, natural increase in PSA or possible BPH may be. Excellent physical health..have used med diet for 30 years (having lived in Spain for a time), exercise and plenty of sleep. So.."go figure" as they say. Remember, every male is different with this disease, so each metric of diagnosis is different. More opinions and perspectives from trained professional is alway the best option.