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  • Just got my 1st PSA 6 months post radiation and ADT.

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    Old 06-29-2020, 02:31 PM   #1
    noonereal
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    Just got my 1st PSA 6 months post radiation and ADT.

    Just got my 1st PSA 6 months post radiation and ADT.

    It is .40.

    6 months ago when the therapies were first finished it was .06.

    I am not sure what to make of it.

    Anyone????

     
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    Old 06-30-2020, 05:06 AM   #2
    IADT3since2000
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    Re: my PSA rise after doing radiation therapy one year ago.

    Hi noonereal,

    It is typical for PSA to rise, a bit, after cessation of ADT and consequent recovery of testosterone. The rise you are seeing could well be that.

    There is also a common phenomenon known as "PSA bounce" after radiation, but I suspect your increase is more related to recovery of testosterone.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured. (Current T 99 6/5/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 07-07-2020, 11:54 AM   #3
    noonereal
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    Re: my PSA rise after doing radiation therapy one year ago.

    My doctor called it concerning and will test me again in a couple months instead of the standard 6 month check.

     
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    Old 08-17-2020, 03:09 PM   #4
    noonereal
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    Just got my 1st PSA 6 months post radiation and ADT.

    My first uPSA after the 26 day radiation and 6 months ADT came back at 0.40. I am to be tested again in 3 months. (my cancer was 4+3)

    It's seems really high compared to the numbers I read here. Can anyone offer anything positive about this number or is it as bad as I think it is?

     
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    Old 08-17-2020, 06:10 PM   #5
    IADT3since2000
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    For patients who have not had prior surgery (the RP), your PSA of 0.4 at this point is a typical number for successful radiation after you have recovered testosterone following ADT. If you did have prior surgery, then your PSA should be much lower if salvage radiation was successful, and a PSA of .4 would be a concern.

    My own post radiation, post ADT PSA (and no prior surgery) is extraordinarily low, not typical. I can explain the likely reasons if you wish, but you should not compare yours to mine and be discouraged.

    I'm a little surprised that the doctor is concerned. Did a radiation oncologist do your radiation, and is this the same doctor or a urologist who may not be well versed in PSAs after successful radiation? There could be a problem, as there could for any prostate cancer patient after either surgery or radiation, but I'm doubting that a radiation oncologist would be concerned at this point. That said, all of us need standard periodic monitoring.

    While I'm confident I know about what I'm posting here, I am a layman with no enrolled medical education, and it's possible I'm not considering a part of the total picture that is framing your doctor's concern. It would not hurt to have that early repeat PSA check. Hopefully it will give you peace of mind and ease your doctor's concern.

    Jim

     
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    Old 08-17-2020, 06:29 PM   #6
    Insanus
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    It’s still early in the treatment. All you can do is hang in there and see happens.

     
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    Old 08-18-2020, 05:20 AM   #7
    Prostatefree
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    If your doctor describes it as concerning, then it is. They know more about you than we do.

    What is your testosterone level?

     
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    Old 08-18-2020, 10:03 AM   #8
    guitarhillbilly
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Quote:
    Originally Posted by Prostatefree View Post
    If your doctor describes it as concerning, then it is. They know more about you than we do.

    What is your testosterone level?
    One of the problems here on this forum is a breakdown in communication or lack of precise communication.

    "My Doctor called it concerning"

    What kind of Doctor? A PCP? A UR ? A Radiologist MD?
    "My doctor" does not provide enough information to even make an educated guess.

    On a side note, "a doctor", depending on their specialty, may or may NOT know as much as you about a particular issue.

    Some folks with a particular disease have done much more exhaustive research about their disease than the Average MD has done or was taught in medical school.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 08-18-2020, 11:54 AM   #9
    Prostatefree
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Quote:
    Originally Posted by guitarhillbilly View Post
    One of the problems here on this forum is a breakdown in communication or lack of precise communication.

    "My Doctor called it concerning"

    What kind of Doctor? A PCP? A UR ? A Radiologist MD?
    "My doctor" does not provide enough information to even make an educated guess.

    On a side note, "a doctor", depending on their specialty, may or may NOT know as much as you about a particular issue.

    Some folks with a particular disease have done much more exhaustive research about their disease than the Average MD has done or was taught in medical school.
    I'll go further and declare the breakdown is a failure to communicate. We get a few details and are expected to make wise remarks.

    A poster is going to get what they put into it. No signature, no history, no help. Regardless of the type doctor, what else can be said other than "Yep, you're right. Sounds serious."

    The exercise of the signature is the number one benefit of participating on these sites, imo. What I gained from writing it, crafting it, reading it again and again is the acceptance of my disease. Knowing what's important and what isn't and a renewed commitment to dealing with it. I consider it a symbol of power in my life.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Old 08-18-2020, 12:29 PM   #10
    DjinTonic
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Setting aside the point that even a specialist MD isn't likely to give advice without an exam, full review of a patien't history, and perhaps additional diagnostic testing, as ProstateFree brought up, there could be some other additional facts in the OP's status that prompted his doc's remarks. When folks ask questions but give no or incomplete histories, it's like trying to guess the person in a portrait when the artist has painted the subject from behind.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 08-18-2020, 03:32 PM   #11
    Southsider170
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Since your doctor's concerned and wants you back in the office you should go.

    But what they are looking for is your post-radiation nadir of PSA, not necessarily a zero. The fact that it was higher a few months ago isn't that shocking as ADT can be very potent in reducing PSA scores and discontinuing it can cause it to bounce.

    0.4 would be a really high PSA if you had a radical prostatectomy, where you are looking for an undetectable score. But you didn't , relax.

     
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    noonereal (08-20-2020)
    Old 08-19-2020, 07:09 PM   #12
    noonereal
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Quote:
    Originally Posted by Prostatefree View Post
    I'll go further and declare the breakdown is a failure to communicate. We get a few details and are expected to make wise remarks.

    A poster is going to get what they put into it. No signature, no history, no help. Regardless of the type doctor, what else can be said other than "Yep, you're right. Sounds serious."

    The exercise of the signature is the number one benefit of participating on these sites, imo. What I gained from writing it, crafting it, reading it again and again is the acceptance of my disease. Knowing what's important and what isn't and a renewed commitment to dealing with it. I consider it a symbol of power in my life.
    you feel better now after this nasty post?

     
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    Old 08-19-2020, 07:14 PM   #13
    noonereal
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Quote:
    Originally Posted by guitarhillbilly View Post
    One of the problems here on this forum is a breakdown in communication or lack of precise communication.

    "My Doctor called it concerning"

    What kind of Doctor? A PCP? A UR ? A Radiologist MD?
    "My doctor" does not provide enough information to even make an educated guess.

    On a side note, "a doctor", depending on their specialty, may or may NOT know as much as you about a particular issue.

    Some folks with a particular disease have done much more exhaustive research about their disease than the Average MD has done or was taught in medical school.
    The doctor is a radiation oncologist at Sloan Kettering, DR. Zelefsky takes the lead.

     
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    Old 08-20-2020, 05:42 PM   #14
    Terry G
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    noonereal, Can you clarify if you have had your prostate removed and then ADT and radiation?

    If you still have a prostate it will continue to generate some PSA and the ADT will temporarily reduce it. As the ADT medication leaves your body the PSA rises a little. With each PSA check your PSA should return to a relatively constant number for you. The road can be a little bumpy and that might be very normal. You can see from my signature that my PSA 3 years following radiation as a monotherapy has bounced around a little and may have not yet stabilized. Some guys stabilize quickly and some may take up to five years to stabilize or as the professionals call it reach ‘nadir’.

    For guys that have had their prostates removed it’s a different situation and even very low levels of PSA are most likely a sign that some prostate cancer cells are still present.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8

     
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    Old 08-20-2020, 06:39 PM   #15
    DjinTonic
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    Re: Just got my 1st PSA 6 months post radiation and ADT.

    Quote:
    Originally Posted by Terry G View Post
    noonereal, Can you clarify if you have had your prostate removed and then ADT and radiation?

    If you still have a prostate it will continue to generate some PSA and the ADT will temporarily reduce it. As the ADT medication leaves your body the PSA rises a little. With each PSA check your PSA should return to a relatively constant number for you. The road can be a little bumpy and that might be very normal. You can see from my signature that my PSA 3 years following radiation as a monotherapy has bounced around a little and may have not yet stabilized. Some guys stabilize quickly and some may take up to five years to stabilize or as the professionals call it reach ‘nadir’.

    For guys that have had their prostates removed it’s a different situation and even very low levels of PSA are most likely a sign that some prostate cancer cells are still present.
    Terry, just one clarification: a PSA nadir is the lowest value reached following treatment. It can come at any time. According to your signature, your post-treament nadir is 0.3. If your PSA ever drops below that figure, that will become your new nadir. For some men their PSA may stabilize at a value that is also their nadir.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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