PSA High Increase 3 Years After IMRT

Hey guys,

Have had quarterly PSA's since IMRT completed August 2013, plus 12 mos. Lupron. PSA result yesterday was 0.50 up from 0.29 in May 2016 (see profile). Was shocked at increase. Don't know if it is a sample error, a bounce, or real. Onc may want to do retest next week. As you see, I had a small 4+3 and 3+3 but did not have 3T MRI when diagnosed. Btw, Duke Cancer Center's policy is ultrasensitive PSA.

Robert

I vote for a retest.

Andrew

Robert-

There really aren't any good tests. Rarely antibiotics will work. It remits on its own usually -- Just wait it out. Your PSA is very low anyway.

Kris,

Wow, you did have a bounce but immediately came back down to 0.3 and have stayed there for a year now. That's great and really encouraging.

I get anxious with this stuff, as Allen well knows. My RO says she has guys at 0.5 for years after IMRT.

Thanks again for the reply!!

Robert

Robert,
At your PSA, a scan will show nothing. Normally a reoccurrence is defined as nadir + 2 or 2.2 in your case.

The fact that it dropped is a good sign. I'd be more concerned if it was just going up.

Now, it's just waiting for your next test.

Hang in there, life is good.
Andrew

Yaamba,
I may be wrong but I think your referring to the ASTRO definition of RT failure that was adopted in Phoenix in 2005 which replaced the 1996 definition.

"In 1996 the American Society for Therapeutic Radiology and Oncology (ASTRO) sponsored a Consensus Conference to establish a definition of biochemical failure after external beam radiotherapy (EBRT). The ASTRO definition defined prostate specific antigen (PSA) failure as occurring after three consecutive PSA rises after a nadir with the date of failure as the point halfway between the nadir date and the first rise or any rise great enough to provoke initiation of therapy. This definition was not linked to clinical progression or survival; it performed poorly in patients undergoing hormonal therapy (HT), and backdating biased the Kaplan-Meier estimates of event-free survival. A second Consensus Conference was sponsored by ASTRO and the Radiation Therapy Oncology Group in Phoenix, Arizona, on January 21, 2005, to revise the ASTRO definition. The panel recommended: (1) a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT; (2) the date of failure be determined "at call" (not backdated).

Messaged my oncologist about doing a 3T MP MRI. This was his response:

"Since the PSA went down from 0.5 to 0.4 I would not do MRI now. The definitions of recurrence after RT are somewhat arbitrary, and I think the ASTRO criteria are much too conservative and out of date. A series of rising values over time is what is important to me. Next PSA in January should be fine."

So PSA has been rising mostly by 100th's until the 0.5. Think I mentioned my Urologist also said "you don't need to do an MRI with PSA at 0.4. However, they will be glad to take your money."

Got a call from Dr. Joe Busch's office since I had inquired about the MP MRI. His assistant said "my Oncologist is wrong. They have seen some guys with residual PC at PSA 0.2. She said after RT, my PSA should be undetectable. I have rarely seen that on this sight or on Inspire. It is obvious, but she commented it is better to find any residual PC sooner than once it is in the LN's.

Robert