SBRT 3-1/2 yrs. out

Hello Ladies and Gents , my latest psa is at 1.20 up from 1.06 at 3-1/2 yrs out.. Check my signature as I had a few bounces along the way .The lowest I had was .83 on 9/2018 . I understand the bounce theory . My question at what psa number will nadir be reached say in a few years from now ? Or what is an acceptable nadir number ? I just wanted to touch bases and say hello to everyone as I found this site in late 2015 . I had my SBRT March 2016 at Illinois Cyberknife under the care of Dr. Erica Hirsh .. At the very beginning I didnt know what to do until I found HW . I had many interviews with top surgeons for surgery , LDB , HDB . I was at 3+3 , 3+3 , 3+4 which was a downgrade from John Hopkins from a 4+3 . Thanks to Tall Allen and many more of you all I took the path to SBRT , no regrets . Wishing you all happy Thanksgiving . SemperFi , John

I have often seen that it is preferred to reach a PSA nadir of .50 following radiation as the initial treatment and not accompanied by ADT. So far you have reached .83, so fairly close so far. Plus, you do not yet know what your nadir will eventually be as many men don’t reach a nadir for five years.

You reference the bounces, which occur fairly common and you are in the timeframe that often encompasses the bounce. If it turns out that .83 becomes your nadir, then you have that plus 2.0 before you would suspect a biochemical recurrence. However, if the PSA trend starts pointing to that your doctors may intervene before such a level. That is why you should stay close with your docs and sty diligent with frequent testing. If you are concerned, you could test more frequently.

Looks great to me, John. I just saw Dr. Hirsch a couple of weeks ago, and I'm in a similar position - bouncing around a bit, currently holding at 1.45, up from 1.32 last time (IIRC). Dr. Hirsch and I are both comfortable with this trend, as she has had patients from 8 or 9 years ago who are still slowly heading downward to whatever their nadir will be. We are currently considering the minor change to be "noise" - especially since I continue to use TRT (before, during and after treatment).

As JNF noted, though, if either of us starts to see an upward trend forming, it could be time for a more detailed discussion. Of course, based upon all the published results, we have every reason to expect that our PSA readings will behave and continue downward.

Congratulations, and may you have many more like these!