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  • PSA Bounce

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    Old 06-27-2020, 09:44 AM   #1
    GuyBMeredith
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    PSA Bounce

    I see a thread about PSA bounce after solo IMRT. I had not seen this information before. Where can I find info on expected results after IMRT with ADT? PSA? Testosterone recovery?
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8
    Aug 2019 PSA 3.1, urologist suggests biopsy in Oct

    Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020

    Side effects, loss of libido, emotional, infrequent warm flashes. The emotional side seems most obvious. Sexual functions okay except ejaculate has changed and without libido it is an academic process that requires much focus.

     
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    Old 06-29-2020, 07:51 AM   #2
    Terry G
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    Re: PSA Bounce

    Although I have no direct or skilled experience on your question; I have been able to get some good information from the studies contained in prostatecancerfree.org. I find the information on the graphs lead to a lot of different studies to check out. You can limit the studies by selecting your risk status and treatment. Since a typical bounce occurrence happens 18 to 36 months following RT I would expect the influence of Lupron to have already passed. I don’t believe the bounce phenomenon is fully understood. Wishing you low PSA numbers going forward.
    __________________
    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
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    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 06-29-2020, 10:22 AM   #3
    GuyBMeredith
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    Re: PSA Bounce

    Thank you, Terry. That is a good observation and, I think, probably my answer.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8
    Aug 2019 PSA 3.1, urologist suggests biopsy in Oct

    Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020

    Side effects, loss of libido, emotional, infrequent warm flashes. The emotional side seems most obvious. Sexual functions okay except ejaculate has changed and without libido it is an academic process that requires much focus.

     
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    Old 06-29-2020, 02:32 PM   #4
    IADT3since2000
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    Re: PSA Bounce

    Hi again.

    I always like to check what the US National Library of Medicine's PubMed (for public medicine) at www.pubmed.gov offers on such questions.

    I did a search that got too many results, but by limiting results only to papers with abstracts published in the past 10 years (a pretty good period to catch modern technology, especially in dosing and imaging, which make a huge difference), I got 36 results with the following search string - prostate cancer AND IMRT AND PSA NOT (post-prostatectomy OR after prostatectomy) NOT recurrent NOT boost NOT proton NOT salvage . You can tell from many of the titles that they are not relevant, but some of the papers probably address the information you are after. I got only a few results when I used "bounce" or "PSA bounce" in the string, which really surprised me as I know it has been well addressed in research. By leaving out IMRT and searching for - prostate cancer AND PSA bounce - with the same filters for abstracts and 10 years, I got 78 hits.

    By clicking on the blue hypertext of each title, you get the abstract of the study, and some have links to free copies of the entire papers.

    Once you are reading an abstract or paper, you can use the Ctrl F combo to find occurrences of key words like "bounce" or "testosterone".

    Hope this helps.

    ….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.

    Last edited by IADT3since2000; 06-29-2020 at 02:39 PM. Reason: Added the "Once" paragraph. Added sentence about leaving IMRT out of a simpler search, yielding 78 hits.

     
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