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Increasing PSA after HDR Brachytherapy Feb 2019

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Posted 3/9/2022 3:00 PM (GMT -5)
Hi
I had HDR Brachytherapy in Feb 2019 with 3 weeks of general beam radiation. My PSA before the treatment was 6.59 and in June 2019 it went down to 1.34 after the treatment. My lowest PSA was 0.73 in Dec 2020.

Since then my PSA has been rising: Dec 2020 1.1, Jun 2022 1.0, Dec 2021 1.5, Mar 2022 1.8 (see my history in my profile)

I was told to expect a "bounce" but my PSA continues to trend upwards. I've been advised to get a PSMA scan to get more information. This probably won't happen until June 2022.

Does anyone have any advice on the kinds of treatments that are recommended or other things I can do after HDR Brachytherapy / general beam when the PSA is rising?

Thanks for your help
Posted 3/9/2022 3:01 PM (GMT -5)
P.S. I will be age 72 in March this year.
Posted 3/9/2022 3:57 PM (GMT -5)
Forward, staying vigilant is prudent. Have all your post treatment PSA’s been with the same lab. Sometimes different labs can provide different values depending on the standards they use. You maybe still in the bounce phase is another possibility. My guess is that if you are in recurrence mode they’ll suggest ADT and more radiation depending on what the imaging suggests. Take a look at my signature to see a case for bouncing. It can take several years to reach nadir. Good luck and keep us posted. Terry
Posted 3/9/2022 9:03 PM (GMT -5)
Thanks Terry! My tests since 2020 have all been at the same lab.
Posted 3/9/2022 9:42 PM (GMT -5)
TWF - about anything can happen with PSA after radiation within limits from what I have observed. The common upper limit is your low PSA (0.73) + 2.0 = 2.73 before recurrence is generally established. You have a few more PSA tests to go before you go too crazy.

The idea of a PSMA scan in the near future seems like a good idea and may provide some needed insight. If a PSA source can be located, targeted radiation may be a possibility. Probably not a good idea to jump to conclusions at this point until your doctor agrees that you are in recurrence which may or may not be the case at this point.

Hang in there.
Posted 3/9/2022 10:28 PM (GMT -5)
Three years is right in the sweet spot for a bounce following radiotherapy as the initial treatment. And many men don’t reach their nadir for as long as five years. Nothing to be too concerned about at this point, but do follow the trend to see what develops. You also could be experiencing some treatment inflammation to the prostate which would increase the PSA expression. This is not uncommon following radiotherapy and usually resolves itself.

See what the June test shows and if it continues up, then be prepared to discuss potential scans with your doc. As to future if there is a recurrence it depends on where the cancer is found. If it is in the prostate bed it may be possible to use focal treatments like HDR, HIFU or SBRT. If it is in the pelvic lymph nodes it can be radiated. If it can’t be found then it is usually suspected to be systemic and ADT drugs are used to control the cancer. But, all that is premature to consider at this time.
Posted 3/10/2022 11:05 AM (GMT -5)
Many thanks Mumbo and JNF for your good advice.

I'll be tracking my PSA again before June and if it's still rising I'll ask my oncologist to schedule a PSMA test.

All the best
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