Bounces: What do we know for sure?

In my opinion, the answer to subject question is not much.

Been reading as much as I could find in the past few days on PSA bounces and my overall sense is the authors don’t know S from S about what causes them, who is prone to get them, or prognostic value.

Maybe I haven’t been reading the latest and greatest studies on bouncing.
The studies I have read involved thousands of men followed over 5-10 years, mostly involving men who were treated with brachytherapy with or without EBRT. They came away with lots of theories, but no definitive answers. Some think two factors help distinguish between a benign temporary bounce and the beginning of eventual BF: interval to bounce and magnitude of the bounce. The problem is bounces can and do occur from 6 to 60 months. Some studies show that men who bounce after their 24-30 month nadir might be more inclined to BF than men who bounce sooner. They admit though that there is much overlap.

Magnitude of bounce might be a another clue to who will fail since some studies show bounces tend to be lower around 0.6 median, compared to 1.2 median for recurrence. Again, much overlap and many men have temporary increases much higher than 1.2 and eventually do very well long term.

Who is prone to having bounces? Early studies suggested younger men, sexually active, with Gleason 6, and PSA <10 had more bounces. More recent studies show men 70 and older bounce more. Some studies showed men with larger prostates bounced more.

What causes the bounces? Not sure about that either, other than having sex right before a test, riding a bike, having a DRE, recurring prostatitis and other well-known causes. Radiation proctitis gets mentioned a lot since it correlates well with the timing of post radiation effect and the median time to 1st bounce of around 18 months. Other than these reasons the researchers just say it’s idiopathic. No mention whatsoever about the often mentioned cause that it’s due to cancer cells with destroyed DNA finally giving up the ghost and entering the bloodstream with its last bit of PSA.

So, here we are after 20 years of studying bouncing and we hardly know more now than when we started. I’m on my second bounce after 36 months of treatment without a clue as to whether it’s just another temporary benign bounce or the beginning of a recurrence. So glad medicine has progressed so far in this field.

Thanks for the reply. Is your last sentence a question for me?

My RO responded to my email regarding this latest increase and reminded me that my biopsy and mp-MRI both showed evidence of chronic prostatitis. He wants to track the PSA every 3 months for a while, so that would mean my next test is April. He said the PSA would need to be 2.75 or greater to warrant further evaluation.

I have my annual urologist visit in March for the DRE. I'll see what he thinks about the bounce. I may try to get him to prescribe an antibiotic before my next April test.

Interesting chart. Looks like the multi-bouncer is beginning to move up again at 72 months.

I wondered too if my recent bump might have begun months ago and I caught it moving down or just moved up recently. As you said, no way to know. I read in one of the studies that benign bounces take on average about 8 months to get back to or lower than the number preceding the bounce.

NK - Don't make me nervous. My recent bump went from 2.15 to 3.0 in 3 months. I am 14 months out from SBRT. Neither my RO nor I am worried. . . yet. Our position is that as long as there is not an upward trend, the occasional up/down activity of the PSA tests is noise. As long as it doesn't trend upward, I'll give it all the time it needs to reach nadir.