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  • what does a .3 psa after radiation

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    Old 09-17-2008, 09:03 PM   #1
    elakovich
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    what does a .3 psa after radiation

    what does a .3 psa after radiation

     
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    Old 10-01-2008, 08:49 AM   #2
    IADT3since2000
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    Re: what does a .3 psa after radiation

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    Originally Posted by elakovich View Post
    what does a .3 psa after radiation
    I'm replying to your post in the middle of last month as you haven't had a response to date. (I have not had radiation, but I considered it, in fact it's still an option as I near the nine year point since diagnosis, relying only on intermittent triple hormonal blockade and supporting drugs, so I've learned something about it as a fellow survivor with no enrolled medical education.)

    The bottom line: a PSA of .3 is not a clear indicator of success or failure after radiation. Unlike surgery, where, ideally, use of a highly capable ultrasensitive test will demonstrate that the PSA is less than 0.01, or at least less than 0.04, or where a conventional test will at least show it to be less than 0.1, some PSA-generating cells often remain after radiation.* Hopefully and commonly they are free of cancer. They often seem to produce a PSA in the low tenths of a percent. My impression is that that is normal and not a signal of a recurrence.

    My impression is that leading radiation docs like to see the PSA finally settle down to 0.2 or below, though some radiation patients do fine with somewhat higher post-treatment PSAs. However, a PSA "bounce" or "bump" happens fairly frequently after both seeds and external beam radiation (proton too, daff?), and that can boost the PSA by a tenth or up to quite a few points for a while. Good books that cover prostate cancer radiation discuss the bounce. It's not a bad thing if it happens, as patients who have bounced before the PSA settles down seem to do at least as well in the long term as those who have not bounced. That said, seeing the bounce in PSA reports has got to be tough on the emotions.

    Of course, a steadily rising PSA probably indicates a recurrence of cancer. My impression is that for most radiation patients it takes a series of PSA tests over a good part of a year to separate bounces from recurrences.

    I hope our guys and gals that have closer experience with radiation for PC will chime in.

    *Sometimes that happens after surgery too, and the PSA will be higher, but will not increase beyond a certain low level unless there is a recurrence.

    Jim

     
    Old 10-01-2008, 10:28 AM   #3
    daff
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    Re: what does a .3 psa after radiation

    Quote:
    Originally Posted by IADT3since2000 View Post
    ....
    My impression is that leading radiation docs like to see the PSA finally settle down to 0.2 or below, though some radiation patients do fine with somewhat higher post-treatment PSAs. However, a PSA "bounce" or "bump" happens fairly frequently after both seeds and external beam radiation (proton too, daff?), and that can boost the PSA by a tenth or up to quite a few points for a while.
    ...
    The "bounce" is certainly in play after proton radiation as well. I'm told that it can take one to two years before things should settle, and the objective is to reach a plateau and just stay there (monitoring of course with future PSA tests, maybe twice a year). I don't think the absolute level is as important as just reaching a point and have no further upward movement. I'm about 10 months post my proton radiation; from around a PSA of 4.0 prior, my PSA first declined to 1.6, then 1.1, and 0.9 as of of August. I'll be quite happy if the drops continue to something like 0.5 and it just stays there, but if I stayed just where I am now, and it doesn't increase, that's ok too.

     
    Old 10-09-2008, 07:43 PM   #4
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    Re: what does a .3 psa after radiation

    Daff - you are right on about the PSAs. Walsh says it should drop to zero immediately after surgery and take up to two years after radiation. My brother's did go to zero after his surgery. Mine went down at every measurement after my radiation for about two years and has stayed below 0.1. The most recent reading was "undetectable". I'm satisfied with that. He says not to get excited unless the PSA goes up for two successive readings after radiation. I hope we don't see that.
    Ken

     
    Old 10-09-2008, 08:23 PM   #5
    daff
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    Re: what does a .3 psa after radiation

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    Originally Posted by kd66 View Post
    ...Walsh says it should drop to zero immediately after surgery and take up to two years after radiation. My brother's did go to zero after his surgery. Mine went down at every measurement after my radiation for about two years and has stayed below 0.1. The most recent reading was "undetectable".
    Ken-
    You have an incredibly low reading after radiation, and that's terrific. The reason it should go to zero after surgery is because there's no more prostate to make any psa. But with radiation, the prostate is still there, thus some psa is too.
    Do you recall the progression of yours- how did the numbers look in the first year after your radiation? What type of radiation and what total dosage did you receive?

     
    Old 10-12-2008, 09:40 PM   #6
    kd66
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    Re: what does a .3 psa after radiation

    Daff - That's a good question. I was wondering myself. I have to look up my numbers and get back to you tomorrow.
    Ken

    Last edited by kd66; 10-16-2008 at 11:04 AM.

     
    Old 10-16-2008, 11:15 AM   #7
    kd66
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    Re: what does a .3 psa after radiation

    OK - here are my numbers. I will list them all; I hope it will help someone to see how they can change.

    In 1999 my PSA was 2.0.
    In 2000 it increased to 3.1
    In 2001 it was 3.7. My doctor had me get a biopsy since it had increased by more than 0.5. The biopsy was negative.
    In 2002 it was 4.6. This time the biopsy was positive, and I had my radiation treatments from Feb - Apr 2003.

    IN july of that year the PSA decreased to 1.3.
    Subsequent measurements at about 6 month intervals were: 1.0, 0.6, 0.3, 0.2, 0.3, 0.2, 0.1, <0.1, 0.1, <0.1, and 'undetectable'.

    The first 0.1 reading was three years after treatment.

    I am certainly pleased with the results.

    Daff - can you tell us more about the proton radiation treatments? How many did you have and did you have any side effects? How did it affect your PSA?

    Ken

     
    Old 10-16-2008, 11:28 AM   #8
    kd66
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    Re: what does a .3 psa after radiation

    I don't remember the actual dosages but they were standard for the treatment. I had 25 external radiation treatments with IMRT followed a month later by Palladium 103 seeds. They used Pd-103 instead of the more common Iodine-125 because my Gleason score was 7.

     
    Old 10-20-2008, 02:17 AM   #9
    daff
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    Re: what does a .3 psa after radiation

    Quote:
    Originally Posted by kd66 View Post
    Daff - can you tell us more about the proton radiation treatments? How many did you have and did you have any side effects? How did it affect your PSA?

    Ken
    Hi Ken-

    Thanks for the followups you posted- sorry I didn't respond sooner, but I've just returned home from a trip, so am now trying to catch up on things.

    I've made many postings on this board about how and why I chose proton beam therapy instead of robotic surgery (or any other treatment) for my prostate cancer-- so those are available if you want to read more. Basically, it's a treatment done in only a few places, but more centers are now being built at costs exceeding $100 million. That's a big reason it's not been widely available, although thousands have been treated since 1990, the vast majority at Loma Linda, California, since there have been few other choices until recently (I went to University of Florida Proton Therapy Institute in Jacksonville about a year ago).

    The treatment consists of 40 (some a little more, some get fewer) daily treatments, that don't take very long. The dosage is 2 Grey per treatment, although there is consideration, and even some ongoing trials, where there will be a higher dosage given to lower the number of treatments. The radiation is very targeted, so that it bombards the prostate but doesn't have an exit dose, so side effects are generally minor versus some other forms of radiation. I experienced a weak urine flow and some burning about 2 to 3 weeks into the process, but that was managed by Flomax and didn't last that long.

    Most patients experience a drop in PSA levels to somewhere between 0.3 and 1.0 after about one to two years-- and then remain at that low point, or nadir. The reason PSA doesn't fall more, is that the prostate is still there and producing some PSA. My PSA was about 4 prior to treatment, and has been dropping, with my 9-month reading at 0.9.

    Please feel free to ask any questions you may have. I learned about this from Robert Marckini's book, You Can Beat Prostate Cancer.

     
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