Post-HDRBT PSA Doubled in 3 Months

Might be a good idea to have a retest before then. Unexpected results should be confirmed.

While it's possible it's just an RT bounce, it is a big jump that you shouldn't have seen.

Do keep us updated on your progress.

Andrew

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I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17 .3 4/18, .4 11/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012

I'd retest.
Looking at your stats, it seems unlikely to me that the increase, if real, results from cancer, especially metastatic. You're a Gleason 6, confirmed by Hopkins, and an MRI shows you're unlikely to have EPE, and your PSA was lower before treatment than your latest. For this increase to be cancer related seems highly unlikely. In fact, if you had not been treated at all it's unlikely your PSA would have increased as much.
It could be a benign bounce (common occurrence), but it's a bit on the high side for a bounce but possible (mine doubled). I don't see that you have a history of prostatitis, but that would be my bet, assuming it's not an error, unless you had sex before the PSA or a long bike ride. Could be prostatitis and a bounce at the same time.
I'd call my RO and have this discussion and not drive myself crazy waiting until mid January.

Best wishes.

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Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2
2nd opinion from JH (3+3)
3rd opinion from UFPTI (3+4)
mpMRI Duke: 50% chance of SV spread
SV fusion biopsy Duke 10/2014 negative
proton at UFPTI 11/14-01/15
PSA:
07/15 2.50
01/16 1.28
07/16 2.56
01/17 .75
01/18 1.41
04/18 .76
07/18 .85

Post Edited (hrpufnstuf) : 11/24/2018 5:34:54 AM (GMT-7)

Even though it seems high to be a bounce, I would bet it is. I would retest to rule out lab error and then get another test in 3 months. I highly doubt if the value represents cancer since it is higher than your pre-treatment value.

Paul

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Gleason 3+4; 5/16 positive cores; average volume 30%; PSA prior to tx 4.8
TX-IMRT + brachytherapy; IMRT Nov. 2011; Brachytherapy Feb. 2012
PSA April 2012--3.6
PSA May 2012--2.5
PSA Aug 2012--2.2
PSA Nov 2012--2.9
PSA Feb 2013--2.8
PSA May 2013--2.1
PSA Aug 2013--2.3
PSA Nov 2013--2.5
PSA May 2014--1.1
PSA Dec 2014--0.8
PSA Jun 2015--0.5
PSA Aug. 2016--0.4
PSA Mar. 2017--0.3
PSA Mar. 2018--0.15

I doubt I could talk with my RO directly either, but I have on occasions called his nurse and she has asked him questions on my behalf and then relayed his answer to me.
Make sure to say how extremely troubled you are over the PSA result and your next appointment isn't until January.

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Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2
2nd opinion from JH (3+3)
3rd opinion from UFPTI (3+4)
mpMRI Duke: 50% chance of SV spread
SV fusion biopsy Duke 10/2014 negative
proton at UFPTI 11/14-01/15
PSA:
07/15 2.50
01/16 1.28
07/16 2.56
01/17 .75
01/18 1.41
04/18 .76
07/18 .85

Jim I hope the PSA jump is nothing. If it is I am sure you will deal with it and get on with life. Here is an interesting article on the subject. https://prostatecancerinfolink.net/2017/01/14/nadir-psa-predicts-survival-after-radiation-and-androgen-deprivation-for-unfavorable-risk-patients/ Best wishes!

69 yrs., marathon runner with knee injury, 41 of 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.

Jim another way tolook at it is you are due some good news!

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65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks. HDR BT completed 2/6/18. 5/3/18 3 month Post HDR BT PSA 1.3, 6 mo PSA 1.2.
Denis

Thank you for your input, Blackjack. So how would I determine if it is prostatitis? I just had my urine checked for UTI, and it came back negative. Should prostatitis show up in a urine sample? If not, how do they detect it and treat it? If not detected somehow, will the urologist just prescribe a round of antibiotics "just in case", then retest the PSA afterwards to see if it helped?

Denis, thanks for the positive words. It's good to see that your PSA is behaving so well! I had my procedures done two weeks after yours, by the same RO at FH.

Jim

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Age 68 at PCa DX
DX: Oct 2017
PSA 7/17 4.22
1/18 4.57
12 Core Biopsy, 4 cores G6 at 10% or less, 1 core G6 at 80%
2nd opinion JH confirms orig. path.
3T mpMRI: 7mm nodule periph zone. No evidence extracap. disease. PI-RADS: 3 Prostate size: 58cc
HDRBT Mono Feb 8 & 22 2018 FH Orlando
PSA 5/18 2.19
8/18 2.50
11/18 5.60

No doubt the amount of the jump concerns you. And it must be followed up with a retest, etc. However, first of all some bounce around is expected with RT, and more importantly: you still have a prostate. Which means you have all of the usual suspects when it comes to sudden increases in PSA. Remember, at these early stages, a sudden big jump in PSA is not normally caused by the PCa, Y'all correct me if I'm wrong. Just like before treatment, if youhad come here and told us your PSA suddenly doubled or tripled in some short period of time, most would tell you that it was probably not PC, more likely BPH/prostatitis, bike riding or that wild session of sex that you had 1 hour before the test.

I am an RP guy, and a while back after being pretty stable with a very slow rise, mine TRIPLED in 3 mos! But then it did not increase at all during the next year or so, even went back down a tiny bit. Turns out they had just got some new machines with a higher bottom limit, and a lot of folks showed a sudden increase.

Lastly, just something to consider: dying PC cells dump their PSA into the blood stream. So, who knows where the extra PSA is comong from? Right now, no one knows. Obviously, you wll be watching it closely, but don't panic just yet! ;)

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PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos, G9(5+4), T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, 1 focal margin )
only rare pad use after 1 year
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17, .06 1/18, .06 4/18, <.05 7/18, .06 10/1

My urologist agreed that my latest PSA reading was quite odd. He has prescribed 3 weeks of antibiotics for possible prostatitis, then a PSA retest. Hopefully we will have a better idea what's really going on after that.

Jim

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Age 68 at PCa DX
DX: Oct 2017
PSA 7/17 4.22
1/18 4.57
12 Core Biopsy, 4 cores G6 at 10% or less, 1 core G6 at 80%
2nd opinion JH confirms orig. path.
3T mpMRI: 7mm nodule periph zone. No evidence extracap. disease. PI-RADS: 3 Prostate size: 58cc
HDRBT Mono Feb 8 & 22 2018 FH Orlando
PSA 5/18 2.19
8/18 2.50
11/18 5.60

VeroJim said...
.....He has prescribed 3 weeks of antibiotics for possible prostatitis, then a PSA retest...
Jim

A good plan as long as it's a relatively mild antibiotic...you don't want 'black boxed' Cipro. It ripped me up and caused C. Diff. Not fun!

The RO you used is very good at what he does. But his firewall communications are a real turnoff. Good luck!

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72years old @ Dx, LUTS for 7 years
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4
RALP 7/17 G3+4 Organ confined, but...
<1mm positive margin on Epstein check
pT2c pNO pMn/a
98% dry, ED minimal
ercMRI & DCFPyL PET Scan @ NIH/NCI
1" tumor remains at apex. No mets.
Persistent PSA .54 after 4 months
2ADT; IMGT 70.2 GY, over 5/18

I have to say I’m surprised at the RO’s scheduling of a PET scan. OTOH, I suppose it’s better to be proactive in these cases than not.
Looking at your signature, seeing Gleason 6’s, confirmed by Epstein, followed by a mp-MRI showing no other suspicious areas and no evidence of EPE, I’d say you were a good candidate for AS, yet you had treatment. Your chances of having metastatic prostate cancer should be remote at worst and practically impossible at best according to all I read. If it is the worst, than it’s a sad commentary for all we think we know about this disease and for mp-MRI’s. If I were an AS guy, it would make me rethink my decision.
I cant imagine they’ll find anything. I pray they don’t.

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Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2
2nd opinion from JH (3+3)
3rd opinion from UFPTI (3+4)
mpMRI Duke: 50% chance of SV spread
SV fusion biopsy Duke 10/2014 negative
proton at UFPTI 11/14-01/15
PSA:
07/15 2.50
01/16 1.28
07/16 2.56
01/17 .75
01/18 1.41
04/18 .76
07/18 .85