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Radiation Bounce

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Posted 4/12/2016 7:28 AM (GMT -5)
I think I understand radiation bounce, but I do not understand why there should be such a bounce when ADT is combined with radiation. Once ADT kills the cancer cells and PSA drops to undetectable, where do the cancer cells come from that later on die from having been radiated at the start?
Posted 4/12/2016 9:08 AM (GMT -5)
Hi CigaFred. I can't give you a definitive explanation, but I can provide my personal understanding. ADT, although does help to kill PCa, it doesn't kill them all so much as it puts them in a starved state. Maybe comparable to hibernation in my own mind....it does slow....even force it into remission in many cases, but not totally eliminated. That's why it's part of a RT, and not a mono-therapy for the treatment-right type of cases and pathology.
Posted 4/12/2016 2:56 PM (GMT -5)
Cigafred-

Are you asking about a bounce after salvage radiation+ADT after prostatectomy? If so, I'm not aware of any such thing. With the prostate gone and ADT suppressing the cancer, the PSA should be undetectable or close to.

- Allen
Posted 4/12/2016 3:16 PM (GMT -5)
As I understand you have the potential for the bounce when you use radiation only. And not all men get the bounce. It generally occurs in the 12-24 month range following primary radiation. If you are also on ADT you would be testosterone suppressed during this time so that would likely override any bounce. If PSA goes up while on ADT it is a sign the ADT is not working, The bounce is not an effect of salvage radiation.

Since you had ADT including Avodart, I would not expect any increase in PSA.

Upon re-reading your signature, did you start with surgery? RP 03/2009? If so there would never be a radiation bounce as surgery would have removed most of the cancer immediately. The bounce only occurs when radiation is used as the initial primary treatment.
Posted 4/13/2016 7:33 AM (GMT -5)
To be clear, I had RP, then SR, then a scan at Radboud that found 8 lymph nodes--para-aortic and common iliac--and at that point we decided on IMRT and 4 months of Firmagon. The radiology oncologist (previously worked with Zelefsky at MSK), whom I greatly respect, said in advance that there could be a radiation bounce in PSA and now it seems there is. PSA was undetectable during the Firmagon, but now rising. So based on the above comments (thank you all) I guess I would not look too stupid to pose this question to the doctors.
Posted 4/13/2016 8:25 AM (GMT -5)
Yes, please ask...and let us know what he says. I'm baffled, but always interested and open to learning something new. I did not think post RP, post SRT bounce was a thing.

Best wishes
Posted 4/13/2016 12:36 PM (GMT -5)
By all means ask the questions. I am inclined to believe it is systemic PCa growing and additional treatment may be warranted. With the mets you have had I am wondering why they didn't put you on at least 18 months of ADT.

I don't think you would be looking for a post radiation bounce like the one that is common when men use radiation only as an initial/primary treatment.

If you are inclined to the bounce theory, how high should you allow the PSA to rise before you start treatment for systemic disease? That is the real question for the doc in my opinion. I would also ask about scans that can be done to try and find the cancer that is causing the PSA.
Posted 4/13/2016 2:23 PM (GMT -5)
Sometimes when there are a lot of mets, radiation (and other treatments) will cause a temporary surge in PSA as the killed cancer cells give up the ghost - but in your case, it is a year later. I'll be interested to hear what your doctor says.

- Allen
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