HealingWell
Search Close Search
☰

1 year post SBRT bad news results!!

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 10/11/2018 4:36 PM (GMT -5)
So I just got my 1 year PSA results. It's not looking good for me as it bounced up AGAIN for a 2nd consecutive test. I'm freaking out of course because this is not a small bounce to go from my lowest of 1.6 to 2.8 to now 3.4!! I am praying the cause could be an ordeal I just went through overseas with a c-diff infection, 3 rounds of antibiotics, and over a month straight of diarrhea, hemorrhoids, bowel irritation, etc. I've been over that for a couple weeks before this test but not sure if it could cause a high jump in PSA like this. Not confident since it was already on the upswing last time. Not that its any consolation but my testosterone came back strong at 572 finally. Too bad I may have to kill it.


Any ideas of where I should be looking as a next step assuming this is a real BCR? Was not expecting to go down this road. Especially this soon after primary treatment. Currently waiting for a callback from my RO.

Frosty
Posted 10/11/2018 5:36 PM (GMT -5)
That's a tough one, sorry to hear it's not good news. You PSA does seem to be tracking T. Has there been any talk of doing some scans to see what might be going on? At 3.4 they should be able to see something.

If it's still in the prostate, you might be able do something like HDR Brachy.

Infection can cause wild swings in PSA, even post RT.

Let us know what the RO thinks.
Posted 10/11/2018 6:12 PM (GMT -5)
Assuming all tests from the same lab.

Looking at that retest number from June....2.0 then 2.8 you can see the possible variance. So 2.8 to 3.4 is <less< of a swing than that retest.

I would retest again in several weeks making sure to do nothing to drive that PSA. If it is up or still in the 3.0> range then I think you have something to worry about. If it drops away to mid or lower 2.0's then perhaps it is just a bumpy road. I try to be an optimist.

I hope the best for you and will be very interested in hearing what transpires for you as I am a SBRT guy as well that is just now 9 months out.

May you be well.

Roger
Posted 10/11/2018 6:33 PM (GMT -5)
A prostate MRI (on a 3T instrument, with contrast) might reveal a reason for the elevated PSA. As mentioned, PSA retesting is appropriate as well, especially considering your bout with Clostridium difficile.
Posted 10/11/2018 7:40 PM (GMT -5)
You are still in the time frame that bounces occur. We have numerous guys on this site that had bounces that extended 3-4 years before the PSA dropped.

One thing you could try would be to take Ibuprofen (400mg-600mg 3 times daily or naproxen 440 twice daily) several weeks before your next test.
My radiologist suggested I do this thinking bounces are secondary to an inflammatory process.

Hang in there. I'm not convinced it is something to worry about yet. Talk to Dr. King. He is an excellent physician.

Thanks
Paul
Posted 10/11/2018 8:10 PM (GMT -5)
So what do your docs say?

It seems there are many variable here that might possibly be overwhelming any small drop that your RT might be causing. The most obvious being a doubled T over just a few months. But I wouldn't be surprised if your ordeal could also contribute. Such an increase in PSA seems a bit much to be caused by a cancer that has been treated. Although, I remember reading several years ago about how dying PC cells dump their PSA and actually result in a rise for a few weeks until there are enough PC cells gone to make up for that PSA dump. Which might be a factor ( or not ) for slight PSA rises for the 1st months or couple of years after brachy, when you would think it could only be dropping.
/www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html

Somebody said...
There is also a phenomenon called a PSA bounce that sometimes happens after brachytherapy. The PSA rises slightly for a short time within the first couple of years after treatment, but then goes back down. Doctors aren’t sure why this happens, but it doesn’t seem to affect a man’s prognosis.....


/academic.oup.com/annonc/article/19/7/1308/320730

Somebody said...
Among patients who achieved either a response or a stabilization, 8 of 41 (20%) had a serum PSA rise during the first 8 weeks of chemotherapy, followed by a subsequent decline in serum PSA. The same observation was made in patients receiving second-line chemotherapy: 6 of 20 patients achieving a response or stabilization had an initial serum PSA rise. The postchemotherapy increase in serum PSA could reach more than twice the baseline value..................An early and transient rise in serum tumor markers (human chorionic gonadotrophin and α-fetoprotein) followed by a drop is a well-known phenomenon which occurs in ∼25% of patients receiving chemotherapy for disseminated germ-cell tumors [21, 22]. The explanation most usually proposed is that tumor markers are released in the blood due to acute cell lysis in this extremely chemosensitive disease...........A PSA rise (without cancer progression) during the first year following brachytherapy is also a well-identified feature in patients with localized prostate cancer and is interpreted as PSA secretion due to local inflammation [28]. A PSA rise during the first weeks following cryosurgery followed by a subsequent decline has also been reported ........It may be hypothesized that this phenomenon corresponds to increased cancer cell destruction, but there is no firm evidence to support this postulate............

I know you are not BT or Chemo, but if dying cells can release their PSA? Who knows?

But I'm no expert on this subject, I'm just sort of thinking out loud. But a doubled T certainly sounds like it could be a factor, plus there might be some other factors, and some more tests wil be needed to help you figure out what the heck is going on. I hope you figure it out soon!

Post Edited (BillyBob@388) : 10/11/2018 7:39:03 PM (GMT-6)

Posted 10/12/2018 9:12 AM (GMT -5)
Hi Frostypro,

My husband had hdr at UCLA, and it has been a really bouncy ride (see signature below). I understand the anxiety, for sure, but it really can be a bounce. Have you talked with Dr. King again? If you want to talk with me or my husband, please get in touch. Also, here's an abstract from a recent study. I can try to locate the full article if you're interested. Stay strong!

https://www.ncbi.nlm.nih.gov/pubmed/30193693

Yours,

Mary
Posted 10/12/2018 9:43 AM (GMT -5)
You haven't reached nadir plus 2, but you are close. Given that your pre-treatment PSA was just over 5 you have dropped considerably in a year until your recent move up. I would be considering options including scans. As was stated, if it is recurrence in the prostate area, there are several salvage methods available including brachytherapy, HIFU and cryo. But you need to see the stuff first. If the PSA continues up and you can't see it, then you have to consider when to treat it systemically with ADT.

What in the world is driving the high T and sudden increase? Nearly doubled in 6 months after being stable. Are you taking something?
Posted 10/12/2018 10:50 AM (GMT -5)
Frostypro: Look at the bounces PJR64 just posted so just maybe all is well. Stayed focused but don't panic yet.

JNF: My testosterone 2017 Oct-401 Nov-331 Dec- SBRT then 2018 Mar-282 Jun-330 Sep-452

So frosty I don't know much about the T levels but I am doing great with what I have.

Be Well

Roger
Posted 10/12/2018 2:37 PM (GMT -5)
Lots of variables there, frosty. First thing I would think of is to talk with Dr. King. After all, he IS one of the most experienced SBRT RO's we have. He may have had other cases in which the patient's PSA was all over the place for an extended period of years after treatment (TA comes to mind), and may be able to tell you what his experience and patient outcomes were in those cases.

It is also possible that your T is exciting things. That may not be a long-term issue, but maybe right now it is. Another resource for a consult may be Dr. Morgentaler in Boston. He has published papers about the impact of T on PCa, and may be able to share some experiences with patients he has followed.

I may be in for a ride much like yours, as my uro and RO are managing my PCa and TRT, with Dr. Morgentaler's advice and guidance. Varying and/or higher than "usual for your age" T may affect readings in the short term, I would think.
Posted 10/15/2018 1:20 AM (GMT -5)
Hi Frosty Pro-

You may remember me as I emailed you prior to my treatment with Dr. King. I finished my SBRT treatment on 2/28/18 so I am a few months behind you but also experiencing a somewhat bumping ride as well, so all may be well.

Six months prior to treatment, my initial PSA was 5.6 at the time of my URO referral and biopsy, but rose to 9.5 (result from blood work for an annual physical) a month prior to treatment at UCLA. My pathology report uses the PSA of 5.6.

At 3 months post treatment, PSA was 3.3 (done at LabCorp as recommended by Dr. King). At 5 months, PSA was again taken as part of a physical and sent to a different lab and PSA was 5.1 Called nurse at Dr Kings office regarding result that that was part of blood screening work because of a significant rise from 3.3 to 5.1 in a little more than 2 months time after first LabCorp result of 3.3. Nurse sent me orders for an immediate retest at LabCorp that same month (August). LabCorp's PSA result was 4.0. Dr. King said this was perfectly normal and not to retest until 6 more months have past from the initial 3 month PSA test. In other words, he only wants a 3 month PSA reading and then every 6 months thereafter.....less anxiety that way too. So hoping for lower than 3.3 for my next PSA test which will be around Thanksgiving. Perhaps we are seeing that "good" PSA bounce while killing off massive amounts of cancer cells!

Sponge
Posted 10/15/2018 8:45 AM (GMT -5)
I'm no expert, but I've been running this race for 5 years now.

By the fact that you showed an initial drop in PSA after radiation and now it's it's rising.

Well, it's not cured.

It's high enough that a PSMA PET scan ought to show you where the residual cancer is.
Once you know your Onco will probably put you on HT of some sort and then maybe spot radiation.
If it shows on scans, they might suggest Zytiga.
Posted 10/15/2018 12:13 PM (GMT -5)
C Diff and the meds you took to defeat it, along with your accelerated T return, coupled with your bouncing PSA, suggest to me your situation is fare from dire.

I can't think of a better RO than Dr. King to be helping you. Too bad TA isn't around for some advise. Maybe you can email him directly.

Good luck!
Posted 10/17/2018 11:45 AM (GMT -5)
Thanks for the replies everyone. Dr. King called back and told me he isn't real concerned at this point. Explained to me how it all works again. Asked him about being close to the +2 BCR rule... he said that +2 threshold is a global range used by physicians for massive numbers of cases or studies. It can go beyond that for individuals in their first year or two and then still continue down to their nadir. He thinks it will be on its way back down. Plus scans wouldn't show anything right now and immediate retest would be pretty useless. Told me to wait the usual three months before test again. Ugh... I feel a little bit better but not much. This doom anxiety thing every so often apparently is here to stay.
Posted 10/17/2018 12:23 PM (GMT -5)
Waiting is absolutely the most difficult thing to in this game. There is so much riding on the result and waiting for the next test result is just an anxiety generator.

I like what Dr. King said.

Andrew
Posted 10/17/2018 12:45 PM (GMT -5)
Dr. King +1

The best most logical medical advise can be tough to accept with this maddening desease.

Relax and stay strong.
Posted 10/17/2018 8:02 PM (GMT -5)
At this point I agree....Try to relax and enjoy the next 3 months....Try to live without thought to that PSA....Umm Right!
But try anyway.
Roger
Posted 10/17/2018 9:06 PM (GMT -5)

garyi said...
C Diff and the meds you took to defeat it, along with your accelerated T return, coupled with your bouncing PSA, suggest to me your situation is fare from dire.

I can't think of a better RO than Dr. King to be helping you. Too bad TA isn't around for some advise. Maybe you can email him directly.

Good luck!

Sounds like if he has Dr. King, he has all he needs.
Posted 12/19/2018 10:24 AM (GMT -5)
UPDATE: I just got my 14 month PSA results. I just couldn't wait for the 15th month because I was sweating so hard over the rather large bounce (+1.8) I had. I swear this doom and gloom anxiety will kill me long before PCa can. Anyway I'm back to trending in the right direction now with 0.9 being my latest result. I'm left to assume my big bounce was due to the c-diff infection and/or that unexplained spike in Testosterone. Or maybe something else with my own journey. Either way I'm extremely pleased right now and feel I can breath easy for at least a little while. Thank you guys for your support.

*notes to self: Say my prayers... and trust Dr. King. If he isn't worried, I shouldn't be worried.
Posted 12/19/2018 11:35 AM (GMT -5)
Excellent news for you! Glad the numbers are going down. Happy Holidays.
Posted 12/19/2018 11:44 AM (GMT -5)
Now that's a nice holiday present. Congrats!
Posted 12/19/2018 11:47 AM (GMT -5)
That's the number you were looking for.
Congratulations.

Andrew
Posted 12/19/2018 12:14 PM (GMT -5)

Frostypro said...
UPDATE:....I'm extremely pleased right now and feel I can breath easy for at least a little while....

*notes to self: Say my prayers... and trust Dr. King. If he isn't worried, I shouldn't be worried.

A long, long while, if you may. Words to live by. cool
Posted 12/19/2018 12:35 PM (GMT -5)
Good news for sure. You're made of stronger stuff than you think to have your PSA checked earlier than scheduled, and right at the holidays. I couldn't do it. I can understand your anxiety, but if it had gone up even further my Christmas would have been ruined. I wouldn't have risked it.

I dread my test in early January. I was .75 in January 2017, bounced up to 1.41 a year later, back down to .76 in April, 2018, then up slightly to .85 in July, 2018. I tell myself it was basically steady for 18 months and the bump up in July was normal fluctuation, but one never knows what's really going on with an increase, and deep down I know it could be the beginning of a BCF and January will be higher. UG, I hate PSA testing.

Again, happy for you.
Posted 12/19/2018 4:25 PM (GMT -5)
Both bounces and slow time to reach nadir have been shown to have better outcomes (though we have many guys that hit nadir in 1-2 years with great outcomes). We have about 6 guys who received brachytherapy that bounced around like crazy and took longer than 5 years to reach nadir. Radiation can be frustrating to those of us that worry even though we know, going in, that bounces are a probable reality.

Congratulations. I think you will do well. You did a great job in choosing your physician. He is a keeper.

Paul
✚ New Topic ✚ Reply
12