Free psa after radiation

Long story short, my psa went up to 10 while suffering prostatitis symptoms, after primary radiation combo with no HT.

PSA has went down as symptoms subsided, over several months, with most recent being 5.6


But, the doctor, who admittedly doesn't know much about it, is concerned that my free psa is only 1%.


I remember the urologist ordering the free psa before I had my initial biopsy, and telling me it showed a high chance of cancer. But never heard much about free psa in men that have already had radiation.

I agree. It's never been validated for that situation as far as I know. How would anyone know what to make of it?

FYI -


Question:

Dear OncoLink "Ask The Experts,"

In June 2003, I finished receiving IMRT for prostate cancer. My PSA readings since then fluctuate between 0.5-2.0, but go up and down, not a consistent rise in the level. My pretreatment PSA was 3.1. I assume from the readings that the cancer has not been eradicated. Can you give me your judgment on how serious my situation is, and what steps, if any, you would suggest? Thank you.
Answer:

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

Serum PSA level is a sensitive tool for diagnosing prostate cancer, but less sensitive at following prostate cancer after radiation treatment. In fact, a number of conditions can make the PSA level rise. The most common besides tumor are prostate infection (I have seen PSA 's over 50 in young men with gonorrhea), trauma (PSA can go up, although not by much, after riding a bicycle and sitting in the seat) and ischemia (lack of oxygen caused by decreased or blocked blood flow, thought to be the mechanism for the PSA bounce that is seen after brachytherapy).

Keep in mind that the normal prostate gland produces PSA, it's just that less of it is leaked into the blood than when there is prostate cancer. After radiation, the free- PSA is not helpful because the radiated gland leaks PSA just like cancer. So, unlike a post-prostatectomy PSA, the result after radiation is not usually zero. I would suggest watching the value and not worrying until the PSA gets to 3. Although, in the case described above, the tumor did not make much PSA initially (given his pre-treatment PSA of 3.0), so it may be difficult to distinguish what's normal and what represents disease recurrence.

Bobby Mac

Although, in the case described above, the tumor did not make much PSA initially (given his pre-treatment PSA of 3.0), so it may be difficult to distinguish what's normal and what represents disease recurrence.


This is just exactly my concern. How do they adjust for low PSA LOW fPSA% G9 BCR as there was never that much PSA in the first place? I go to see MO for nadir check on March 6Th .I'm going to ask him.
Maybe some have some info here that will help us understand more?

Battle On!

The Artistic One - -Mark