Alarmed by new PSA 1 year post SBRT

Hi Folks-

I had SBRT at MSKCC in Feb 2017.
Original PSA was 7 with a G7 ( 3+4 ).
Just got the most recent PSA back and I am very concerned.
Have an appt. with RO first week in Jan. 2019
Looking for some help on how to think about this "setback" and putting things in perspective.


12/07/2018
2.43 ng/mL

06/15/2018
1.63 ng/mL

03/16/2018
1.66 ng/mL

12/08/2017
2.44 ng/mL

06/02/2017
2.13 ng/mL

Post Edited (Bosco) : 12/9/2018 8:09:05 AM (GMT-7)

Is a bounce typically that much ?
I assumed a bounce was a few tenths like I had earlier.
Is it typical to have more than one bounce ?

bouncy. You're in that time range.

You don't really have anything to worry about until you see a consistently rising pattern over a number of tests.

Just keep monitoring.

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

one or even two tests increasing is not to worry. RT is a much more long term ride than is RP.
Be well.

Roger

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69yo at DX
PSA Pre TX 6.47 to 5.56
DX 8/11/17 5/16 cores positive all on left
L mid/base 4/6 4+3=7 25% of core
L apex 1/2 3+4=7 30% of core
SBRT Dec 2017 3625 cGY 5 fractions Swedish Seattle Dr. Robert Meier
Post TX Lab#1 3mon 2.03 6mon 2.20 9mon 1.03
Lab#2 3mon 1.82 6mon 1.30 9mon 1.00

Bosco..... Look at my signature if you want to see a bounce. But like all have said, it's part of the drill with SBRT. Unless and until you get several increases and establish a definitive upward trend that is consistent, then likely you are simply experiencing typical bounce that is to be expected. Either way, there isn't a thing that you can do about it and worrying doesn't help so forget about it and get on with your life. Right now, you look good.

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Dx Age 69 01/17
3 of 12 cores positive G 3+4=7, L3 left apex 60%, L5 left lateral mid 50%, L6 left lateral apex 30%, and R3 right apex: Focal high-grade prostatic intraepithelial neoplasia
PSA: Jan17-7.3
SBRT July 2017 Cyberknife Center of Tampa with Dr. Debra Freeman
PSA: Oct17-2.50-T level-386
PSA:.Feb18-1.64
PSA: Apr18-1.76-T level-343
PSA: July31-1.78-T level-356
PSA: Oct31-3.78-T level-355

Bosco said...
Thank you all for sharing your thoughts and allaying my fears. I am sure my RO at MSKCC will have similar thoughts when I see him after the New Year.
I have also noticed that my T-level has been dropping. about a year ago I was at 345, then dropped to 262 and now I’m at 218.
Any thoughts on that?

Not sure about your T level and that certainly may be completely independent of SBRT and PC in your situation. Again, my signature shows relative consistency with T level through all this. And your age may be a part of that issue. I'm 71 so it wouldn't surprise me to have a T level decline but I sure hope to avoid that as long as possible. That's an issue for your doc. There are SBRT guys here who are boosting their T level under their Drs supervision. Paxton comes to mind. Try reading his threads.

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Dx Age 69 01/17
3 of 12 cores positive G 3+4=7, L3 left apex 60%, L5 left lateral mid 50%, L6 left lateral apex 30%, and R3 right apex: Focal high-grade prostatic intraepithelial neoplasia
PSA: Jan17-7.3
SBRT July 2017 Cyberknife Center of Tampa with Dr. Debra Freeman
PSA: Oct17-2.50-T level-386
PSA:.Feb18-1.64
PSA: Apr18-1.76-T level-343
PSA: July31-1.78-T level-356
PSA: Oct31-3.78-T level-355

Post Edited (19tarpon47) : 12/10/2018 9:53:52 PM (GMT-7)

tarhoosier - You've lost me with this info. Way above my pay grade. The OP was a G3+4=7 at diagnosis, which is hardly a "high G" case.

I think he is just having a bouncy ride on the way to nadir. TA was/is a good example of this, as his case took about 6 years to nadir.

In my own case, I am now just over 2 years post-SBRT. My PSA started at 5.69 pre-treatment. It went down, then up, then level. . . until the 2-year point, at which it reached a new nadir of 1.9. That's the lowest it has been in 6 or 7 years. My RO and I are both comfortable with this, and will just watch it until we get bored with it. Unless it shows a clear upward trend of some significance, there is just no reason to become at all alarmed. Nothing to do but practice patience. . .

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Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

Bouncy, bounce. Good number!!!

Down is good,
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

Bocso, I'm glad things are back on track!

Jim

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Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
https://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

Bosco said...

Paxton - I don’t think I have any symptoms attributable to low T but I’m curious what symptoms you had that I might look out for ?

Well, let's see:
1. Depression (like seeing your life in black and white, while everyone else sees Technicolor)
2. Foggy brain - made lots of mistakes, which was unusual in my professional history; forgetful but too young for that
3. Loss of muscle mass
4. Loss of exercise tolerance
5. No libido
6. Weight gain
7. Strange emotional swings; moodiness; grumpiness
8. Didn't like life at all

If this sounds like not so bad a list, try having all of them at once. . .

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Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23