PSA "Bounce" in brachytherapy patients

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 187
   Posted 1/19/2011 3:15 PM (GMT -7)   
Anyone familiar with or have any experience with this notion of a PSA bounce after brachytherapy.
 
PSA Results
April 2009- 3.4
May 2009- Brachytherapy
Nov 2009-  1.9
May 2010-  1.1
Nov 2010 -  2.4
 
My family doctor seemed very concerned about the doubling of the PSA  but my radiation oncologist was not- he told me to have another PSA in three months rather than six months- referred to this PSA bounce as not unusual for many brachytherapy patients.
 
I did some research- one study from the Radiotherapy Clinic of Georgia in Decatur says the bounce " is thought to be due to inflammation of the prostate, a condition that causes PSA levels to rise independently of any possible cancer. Men who undergo brachytherapy and have a bounce also experience symptoms of an inflammed prostate, such as a burning sensation during urination."  ( I have the burning )
 
Another theory from the Anderson Cancer Center in Houston says the bounce in PSA may be caused " by death of damaged cancer cells that then release their PSA." - no reason for concern.
 
The Cleveland Clinic team reported that a "PSA bounce may be associated with improved biochemical relapse-free survival."
 
"Immediate salvage therapy in patients with a rising PSA level after permanent prostate bracytherapy should not be initiated provided the PSA increase does not exceed the pre-treatment PSA value."
 
"PSA bounce predicts early successs in patients with permanent iodine-125 prostate implant."
 
All very interesting - any thoughts or comments are welcomed.
 
 
 
 
 
 
 
 
 
 
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 722
   Posted 1/19/2011 3:23 PM (GMT -7)   
I think your family Dr. does not know anything about PSA bounce which is commonly documented all over the place. I think that is exactly what you are experiencing. What did your Uro. say about it.
Dx @ 42years old on 4/2008
Gleason 6 (tertiary score 0)
open RP 10/08 Johns Hopkins
pT2 Organ confined Gleason 6
PSA
10/15/2009 <.1
10/15/2010 <0.03
10/15/2011 -

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1781
   Posted 1/19/2011 3:23 PM (GMT -7)   
I just had HDR brachytherapy and both my urologist and rad-onc explained the bounce and that I should expect it somewhere between 12 and 24 months after treatment. Another theory is that some of the healthy prostate cells remain and start a slow recovery and regrowth and give off a little more psa at some point. Basically, they really don't know exactly why the bounce occurs but have their theories and observe that it is normal in the recovery after the brachytherapy.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3279
   Posted 1/19/2011 3:30 PM (GMT -7)   
my radiation onc says the chances of a spike are 15%. 
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 469
   Posted 1/19/2011 3:48 PM (GMT -7)   
mj,  Here is a paragraph from the American Urological Assoc. 09 Official PSA Guideline:
 
"The change in PSA following interstitial prostate brachytherapy is complex. Over the first year,
the PSA level declines, then rises again in the second or third year in up to 40% of cases, only to
fall back to much lower values by year four.225-227 Although these rises (or “benign bounces”)
are generally small (<0.8 ng/mL), they can, on occasion, be as high as 10.0 ng/mL, and they may
last for 6 to 18 months. Their cause is uncertain, but they may correspond to infarction of the
prostate occurring as a late vascular effect of the radiation. The principal concern regarding the
benign bounce is that it may be confused with failure and lead to the initiation of unnecessary
additional therapy. Ironically, bounces may actually predict a particularly good ultimate
outcome."
 
Hope this helps.
Carlos

Dx 2/2008, age 71, PSA 9.1, G8,T1c. daVinci surgery 5/2008, G8(5+3), pT2c. LFPF, good QOL. PSA <0.1 for 2 yrs. PSA rose to .2 at 30 months, started SRT 12/15/2010.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3760
   Posted 1/19/2011 4:59 PM (GMT -7)   
My oncologist says "The only way a cancer reoccurrance can be distinguished from a "bump" is to check psa levels monthly. Men with a bump have psa levels seesaw up and down whereas a steady rise in psa denotes a relapse"
JohnT

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2784
   Posted 1/19/2011 7:00 PM (GMT -7)   
MJ, I had quite a lengthy discussion with both my radiation oncologist and urologist (who assisted with my brachy) on the subject of PSA bounce.  They assured me up front that this is fairly common and I should not be overly concerned with some bouncing around with my PSA readings as long as the overall trend was down.  And, that it might take a number of years before reaching my nadir.  That advice is also consistent with the research I did.  They did tell me that if an uptick occurred they would start testing my PSA every couple of months.
 
Don't be too hard on your PCP as I think if you spend a few hours on HW you may be more informed about PCa than most internal medicine docs. 
 
Also, if it's any consolation to you I can relate an anecdotal story from one of my tennis buds.  He had brachytherapy about 8 years ago.  At the two year mark he had a PSA spike similar to yours.  His new urologist (as he had moved) knew nothing about PSA bounce and was ready to refer him to a surgeon for salvage surgery.  Fortunately my friend called his radiation doc who explained PSA bounce and started more frequent PSA tests.  The last chapter is that the PSA resumed it's downward trend and he is now registering close to zero.  Hopefully this will be your story as well!!!
 
Best wishes,
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24336
   Posted 1/19/2011 7:19 PM (GMT -7)   
Great explanation, Tud, as usual
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 187
   Posted 1/19/2011 8:22 PM (GMT -7)   
Thanks to all for your comments and words of encouragement.
Chris asked what my uro said - My urologist provided the initial cancer diagnosis post biopsy- told me if I did not have surgery I would die.
I haven't seen him since. I see only the radiation oncologist and to date I am content with my decision on brachytherapy.
My family physician is a great guy but I agree that he probably knows little about brachytherapy or a PSA bounce.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 343
   Posted 1/21/2011 11:31 AM (GMT -7)   
From what I understand, totally normal.  My husband experienced it at 18 months out.

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 187
   Posted 1/21/2011 11:59 AM (GMT -7)   
Thanks Julie for the words of reassurance.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 1/21/2011 1:11 PM (GMT -7)   
mjluke,
 
My Rad/Uro team both explained BT bounce to me in almost exactly the same terms as described by Tudpock above. Seems to be pretty common...sounds like you are in good hands.
 
Joe
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 187
   Posted 1/21/2011 2:10 PM (GMT -7)   
Thanks Joe

malisha
New Member


Date Joined Nov 2012
Total Posts : 2
   Posted 11/7/2012 5:20 PM (GMT -7)   
Hellothere.  MY husband had brachytherapy in October 2010.  PSA was going down until today went up to 1.8.  He has burning sensation for past 3 months when beginning to urinate.  Urologist doing a coloscopy to check inside.  He said sometimes brachytherapy can cause scaring which then can cause PSA to rise.  Hope this is all.  Any more feedback from anyone?

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5953
   Posted 11/7/2012 6:34 PM (GMT -7)   
Malisha,
I'm going to open a new thread for you so that you will get better attention. This thread is rather old.
 
http://www.healingwell.com/community/default.aspx?f=35&m=2557611
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12

Post Edited (142) : 11/7/2012 5:37:12 PM (GMT-7)


PDL17
Regular Member


Date Joined Oct 2011
Total Posts : 255
   Posted 11/7/2012 7:55 PM (GMT -7)   
Mjuke,

Your urologist was so inappropriate by telling you that you would die without surgery. That borders on malpractice.

I assume you fired him. Good for you in doing due diligence and research.

Paul
New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, November 25, 2014 9:58 PM (GMT -7)
There are a total of 2,278,072 posts in 253,209 threads.
View Active Threads


Who's Online
This forum has 158675 registered members. Please welcome our newest member, ron_from_ct.
389 Guest(s), 18 Registered Member(s) are currently online.  Details
proscapt, Chapelle, maggiesfour, Colita, Lily'sGma, pb4, Tbrown2, geop, Daesin, Scaredy Cat, jbart62, lesweet1971, platinumpixie, TooMuchAnxiety, Fnp256, ron_from_ct, RockerGirl, sueg


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest  Follow HealingWell.com on YouTube
Advertisement
Advertisement

©1996-2014 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer