Should PSA Super Dive Warrant Updated Imaging?

Depending on the radiation protocol they’re using and whether they’ve completed pre-treatment planning yet, they’ve probably already done (or will be doing) a pre-treatment CT Simulation, and will be doing a low-level CT scan at each treatment for comparison purposes.

If your radiation treatments are already scheduled, then they should’ve already gone over this with you In excruciating detail.

You should ask them about this.

Do you have the full bladder/empty bowel routine down yet?
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Regarding the ADT and your PSA levels (0.63 ng/mL) —> Having been on ADT for 2.5 months, optimally your PSA should be nearly undetectable and your testosterone levels should be below 50 ng/dL (preferably below 20 ng/dL). (At 2.5 months, my PSA was at < 0.008 ng/mL - and testosterone in the low double-digits.)

What ADT are you on?

How long do they plan on you being on ADT?

What were your MRI, PET/CT scan, and biopsy results?

Good luck with your treatments!

As Brian said, you will get an updated scan during your treatment simulation. Not really a "super dive" on your PSA. I started ADT on 6/7 with PSA of 30.11. Went to 0.55 on 7/9 and 0.19 on 8/26. You're doing fine and good luck with treatment.

Along with Brian's questions above, what type of radiation are you planning for? Any discussion of fiducials or spacer?

thanksforsharing, mjp512 and brianjarvis have given you excellent information. I'm only chiming in to say that in the case I'm most familiar with ADT reduced the tumor size by nearly half in three months.

When you have radiation to the prostate, they essentially melt the whole thing down. Having another test to see what’s going on is sort of irrelevant. That will make no difference in what they will be doing with the radiation.

If you were having focal therapy, it would be a different story since they don’t always obliterate the whole prostate, But with radiation, it is going to be effectively gone so doing more testing Won’t be beneficial.

@jeffmarc It’s my understanding that with radiation;
> they don’t “melt the whole thing down”
> they don’t “obliterate the whole prostate”
> the prostate is not “effectively gone”

The prostate is still intact, about 1/3 the size that it was, still producing PSA, but does have some damage.

The DNA in all the cells are damaged, but the cancer cells are unable to repair themselves, and die as they try to multiply. The healthy cells that were unable to repair themselves also die as they try to multiply. (Both being reasons why the 1/3 size.)

The healthy cells that were able to repair themselves continue to function, producing PSA (though now at “new normal” lower levels).

Unlike a prostatectomy, where the entire prostate is removed, the goal of radiation is to kill the cancerous cells, and leave behind as many healthy cells as possible.

@brianjarvis
You are correct.

My thinking was that because it is so difficult to do the surgery after radiation that there was not enough left to really have any normal function. Not quite true.

@jeffmarc Dr. Rossi has a lot of information about radiation (primarily proton) in his portion of this 2023 Mid-Year PCRI presentation: https://www.youtube.com/live/WTqPnSRYtW4
—> Starting at about 3:38:45

There’s a Q&A session at the end of his presentation. He’s asked “What happens to the prostate?” at about 4:56:30.

@brianjarvis
I’ve actually seen that video and saved some notes from it.

I’ve actually quoted here from statements made in that video.

I may have missed the QA at the end on that specific discussion. Will check it out.

@brianjarvis
Just listened to to his explanation about hat happens to the prostate after proton radiation (He sort of implied any radiation). It shrinks 30 to 40% And if you have hormone therapy that shrinks even more.

With that much left, I wondered if BPH is a possibility after you have prostate radiation, and sure enough, a search of AI says it is possible and it’s not uncommon. Wonderful!

@jeffmarc I would think that since BPH isn’t necessarily related to prostate cancer, that having an enlarged prostate is relative to the size of a normal prostate,

Post-radiation treatment, an enlarged prostate due to BPH would be relative to its 30%-40% “now normal” smaller size.

(I’m still not onboard with taking everything AI says without some background.)