PSA higher after treatment

Welcome to forum. It would help a lot if you can supply some specifics. His PSA history prior to, and after treatment for starters. His Gleason score and any other biopsy information.

Prior to treatment 7.4. Today 8. Dr said possibly due to inflammation.

Post Edited (Midge411) : 12/31/2019 7:33:09 PM (GMT-7)

Hello, no direct experience with SBRT but a PSA test so soon after treatment ends does not mean much with radiation treatment. The prostate is still there and mortally wounded thus PSA is still there for a long time. I know it is hard but you need to get 3 and 6 month results before being worried about anything. Talk to your doctor about it when you get a chance. Those who know more about this should respond after New Years Eve, a slow night for posting.

Midge411 said...
Prior to treatment 7.4. Today 8. Dr said possibly due to inflammation.

Definitely possible. Also, though we don't read much about it, I have read that dying PC cells dump PSA into the blood stream. So, rapidly dying cells can actually temporarily raise PSA. I remember an 8 week clinical trial I read 6 years ago. In the placebo group and other treatment groups, the PSA- which had been rising steadily in these advanced cases- continued to rise at about the same rate. In the treatment group, the PSA rose even faster than placebo fo several weeks, and then began falling rapidly as placebo continued the steady rise. So, it appears that PSA can rise as PC cells are first starting to die off.

However, as well as the usual PSA, they used Homocysteine as an another method of measuring tumor load. While this continued unchanged or rose in the placebo group, it dropped from the first week steadily for each of the 8 weeks in the treatment group. So, IF homocysteine is actually a useful method of measuring the amount of cancer, this means cancer cells were dying(indicated by dropping homocysteine levels only in the treatment group) while PSA was increasing. This continued until the tumor had shrunk enough to compensate, with lower PSA production, for the PSA being dumped by the dying cells. Don't hold me to any of that, just something I read a few years back. Also, seems to me I have seen people after radiation have their PSA, after a steady decline, rise for a short time before it started to drop again on it's way much lower. Point is, inflammation or maybe other things might make the PSA rise for a while, even if PC cells are dying. Which I hope is the case.

Post Edited (BillyBob@388) : 1/1/2020 7:24:48 AM (GMT-7)

Hello Midge411 and welcome.

I completed SBRT at the end of this past August. At that time, I told my RO that I was scheduled for my annual physical with my primary physician in about six weeks and he routinely tests my PSA levels every six months. The RO told me NOT to get my blood drawn for PSA testing as the results would be skewed. He says the PSA levels are wildly inaccurate so soon after radiation and only tend to upset the patients. In all my research prior to treatment I never found PSA testing after radiation before the three month mark. As a side note, the staff at my RO's office was particularly careful not to schedule my first follow-up visit before the three month mark because it would not be covered by my insurance company. At three months, my PSA level had dropped 69% from my last pre-treatment test.

You may want to do some research on this site about the treatment process of radiation on the prostate. It might help with understanding how PSA levels fluctuate right after treatment and also explain "bounces" down the road, if they occur.

I do know that some post-prostatectomy patients are PSA tested earlier than the three months, but personally I feel like five weeks is early.

Should not have had the PSA test so soon. Radiation takes months to years to effectively kill the cancer. It damages the cancer immediately rendering it harmless, but it will still express PSA for some time. And the healthy prostate tissue has been damaged by the radiation and is healing itself and replacing damaged tissue. All this will express PSA. Your doctor references inflammation. This is the process simplified. A minimum of three months should have been the first post treatment test. Relax and disregard the test. It is meaningless.

I'm another SBRT patient. After treatment, my PSA took a long time to do much of anything. The first test was at 12 weeks, and it only showed a modest drop. I am not over 3 years from my last treatment, and my PSA continues to take its own sweet old time gradually dropping. It has hit plateaus, it has bounced up, and down. As long as the trend is downward, I'm fine with it.

As for a 5-week PSA draw, I am surprised the RO chose to do it. That does seem very soon, and I would bet that my own PSA at 7 weeks would have been up, because I had all sorts of inflammation for the first few months post-treatment.

As the others have said, for radiation patients, it doesn't make sense to get worried about any one test, as the impact of radiation therapy takes a long time to show. I know one former member here who had SBRT, and his PSA took over 6 years to hit nadir (its new minimum level).

Sorry, F8 - I should have at least qualified that I am not at my work computer, so I do not have access to the file with all the historical data. Will have to add it later.

I, too, have read where radiated prostate cancer cells can dump psa into the bloodstream.

testing that soon after radiation treatment is begging for trouble. I know my first test was after it was assumed testosterone had returned. my doctor explained the number he wanted to see and the number that would concern him.

the result was .2. and the next one was .3. man I was a mess

Paxton said...

F8 said...
"I'm another SBRT patient. After treatment, my PSA took a long time to do much of anything. The first test was at 12 weeks, and it only showed a modest drop"
would have been more instructive and reassuring to provide the numbers.

OK - I've got the data:
Pre-treatment PSA 5.69
Treatment in Nov. 2016
01/2017 PSA 4.75
04/2017 3.03
07/2017 2.86
10/2017 2.15
01/2018 3.02
04/2018 3.04
10/2018 1.93
04/2019 1.42
10/2019 1.55
So, my PSA did not decline very much at first. (And we have NO idea what it may have done between treatment and the 90-day PSA test.) It then declined gradually, bounced, and then again declined gradually. My RO and I are fine with this, as long as there is no defined trend back upward. We don't expect one. We are just "staying the course."

cool, thanks. your first PSA was in the first two months it looked like and barely dropped! I think that's what we are seeing with the OP