Rising PSA after SBRT - worrysome or to be expected?

Posted by markbaldridge @markbaldridge, 23 hours ago

Five years ago, I was diagnosed with Gleason-9 PC and had a prostatectomy.

Shortly thereafter, I had a biochemical recurrence and had 39 IMRT treatments on my prostate bed and pelvic region. I also had 18 months of Firmagon.

One year later, I had another biochemical recurrence and had SBRT on my Lumbar + Rib. In addition, I had 6 months of Eligard.

One year later, I had a PMSA/PET scan which revealed a metastasis on my sternum. I subsequently had SBRT on this lesion on my Sternum (but no hormonal treatment).

For my most recent SBRT on my sternum, my PSA was 0.75.
After 3 months, my PSA rose to 0.81.

Is it considered normal for my PSA to rise 3 months after my sternum SBRT?

How long would you expect my PSA to become undetectable or near-undetectable after receiving the sternum SBRT?

Thank you very much,
Mark

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jeff Marchi | @jeffmarc | 21 hours ago

Your situation is not normal, Unless you consider more metastasis occurring, that is causing your PSA to rise, normal.

You need to get a PSMA PET scan to find out where else something has come up.

Your PSA should slowly drop after having SBRT. You could wait three more months and see if it continues to rise but it’s almost definite you have another metastasis with a Gleason 9. They could be so small you can’t see them on a PSMA PET scan

You should have stayed on ADT after having the second Reoccurrence. You actually may Need to be on both ADT and an ASRI to keep your PSA dropping and stable for a while.

I’m not sure where you are getting treated, but the standard of care should’ve had you on both of those drugs after the second reoccurrence For at least two years.

Of course you can always follow the Mark Scholz Treatment plan where you just get continuous PET scans and keep getting the metastasis zapped. With two reoccurrences, your cancer is definitely in your bloodstream and you could find you will have metastasis all over your body If you don’t get aggressive treatment.

You are a Gleason nine, That pretty much guarantees you are going to have reoccurrence. It’s up to you how you want to handle it.