SBRT , 5yrs out , PSA

Your post-treatment nadir is your lowest value, which appears to be 0.83. If a future reading drops below that, it will become your new nadir. Your signature doesn't mention your pre-treatment PSA.

Wishing you all the best,

Djin

Looks like so far, so good. You know you will have some PSA since you have an intact and, probably somewhat, functioning prostate. The question always is, how much PSA is from benign tissue and is any of it from PCa?

Based on decades of evidence, experience and thousands of studies, it is generally accepted that post radiation treatment of nadir plus 2.00, or less, is a level that indicates benign tissue only. Go above that and it is often an indicator of PCa. You are in that range as your nadir looks to be .83, so you could go to 2.83 within the guidelines. You also know about the bouncing around that PSA often does after radiation treatment. Which you look like you have experienced.

The trend is important and the most recent increase following the bounces and decreases has to be considered. Is it an outlier? Are you still bouncing a bit? Do you have some infection? Did you have sex a day or two before the test? Does it signal some PCa activity? All need to be considered.

I would clearly be on a three month test schedule in light of the increase to closely monitor the situation. I would also be prepared to face some investigative scans should the increase continue. When your doctor delivered the results what was the discussion? Have you spoken to Dr. Hirsch concerning the increase? Does she still follow you and is she aware of the increase?

A 68Ga-PSMA-PET scan is generally superior to an Axumin (18F) scan, but (1) FDA approval for it for it is new and insurance coverage is probably not fully implemented and (2) its geographical availability is spotty. Axumin has an advantage when bladder involvement by the PCa is suspected. The Gallium radionucleotide is eliminated mainly by the kidneys, so the whole bladder "lights up," making it hard to visualize tumor, whereas Auxumin is metabolized mainly by the liver, which makes lesions discernable at the bladder-urethra junction. At your PSA level, I think an Auxumin scan would still be very good. But this is certainly something you can discuss with your docs.

Djin

John,
I think I would have that talk with Dr. Hirsch before I would start choosing next scans to have. As JNF suggested, she may want to get another PSA in a few months to see if there is a trend or if this is another bounce. Of course it could be either, but I would more likely bet on another bounce. After all, your prostate was pretty completely "nuked" in treatment, and your pre-treatment pathology was favorable intermediate risk.

Personally, I have accepted that PSA readings after RT are just going to "rattle around" a bit. I just watch mine for any emerging trends, but one or two readings could still be "noise" in the stats.

Keep us posted, please.