PSA Levels After Surgery and Radiation

amm8589 · New User Joined: 23 Apr 2008 Posts: 4

My father was diagnosed with prostate cancer in October 2006, Gleason scale 7. He had it removed the following month. Subsquent PSA levels were zero for one year, then he had a .23 PSA reading. He did 10 weeks of daily radiation, which concluded in January. He just went back today for his follow up, and his PSA was .8. The doctor said sometimes the radiation "stirs things up" and it can take a while for the reading to go back to zero. He wants to wait three months and test again. If it is not zero, he wants to start hormone therapy.

Does this PSA level sound okay? I'm thinking it should be zero since he does not have a prostate. I don't think waiting another three months is a good idea. Maybe a second opinion would be in order. Does anyone have any opinions or feedback?

Thanks,

amm8589

Replicant · Moderator Joined: 01 Nov 2006 Posts: 129

To me (a layperson who's been through salvage rad and read a lot about it--no other qualifications) 0.8 doesn't sound high OR low. It depends on where his PSA was right before radiation started.

If salvage radiation is successful it can take several months to a year before it reaches nadir (the low point). What you want to see is PSA to fall not necessarily to zero, but to 0.1 or below. That's what Dr. Andrew Stephenson, a leading researcher in this field, calls a "complete response." And for optimal long term results you want to reach the nadir within a year or less (that's roughly the time as I remember it.) The sooner the better.

It's not so much that radiation stirs things up, as it is the way the cells die. Radiation kills the cancer by disrupting its cell division. You're waiting on the die-off to finish. It's not abrupt, but a downward curve. So the important thing is the trend over time.

Do you know what the PSA was right before radiation therapy started? My PSA was 0.7 the day before salvage therapy. My first PSA was still detectable at 0.1 after treatment. The oncologist said he would have been happy if it was as high as 0.3--but that's based on where I was before treatment. Later my PSA fell below 0.1. I'll find out in a few weeks if it's still there.

In a nutshell--you want to see PSA trend downwards now and reach 0.1 or less within a year or so from the end of radiation. Then the chance for a durable response--or cure!--will be the highest. Any other result will be a cause for concern.

I know about the anxiety. There's not much to do but wait now, and see how the next PSA test comes out. There's no reason to think it won't be good news then.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 129

I see that you reported his PSA as 0.23 some time after surgery. Was that right before radiation started?
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

amm8589 · New User Joined: 23 Apr 2008 Posts: 4

The PSA level was .23 just before radiation. It is now .8, which is an increase. The doctor said the PSA should be checked again in three months, and if there is no improvement, hormone therapy would begin. I just think that the PSA level being HIGHER now than before radiation was started is not a good sign.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 129

Thanks for specifying that. I agree with you about the outlook. Only time will tell.

Remember, even if SRT didn't cure your father, he's not necessarily under a PCa death sentence. Hormone therapy (ADT) can stop prostate cancer in its tracks, at least for most men. For some, it can work for over a decade. And there are lots of new treatments in the pipeline.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

amm8589 · New User Joined: 23 Apr 2008 Posts: 4

Thank you so much for your response. I'm trying to maintain a positive outlook. My father is going to get a second opinion. I will keep you updated.

amm

amm8589 · New User Joined: 23 Apr 2008 Posts: 4

Just wanted to give an update. My father went for a second opinion and was told the same thing - wait another three months for a more accurate result. My dad was then told by a friend that he knew of somebody who was once told the same thing, and that the PSA level did indeed go way down between 3 & 6 months. So we are just waiting until July for the next PSA test. Will keep everybody udpated.

Thanks,

amm8589

brainman

amm8589, just wanted to say that I am thinking about and praying for you and your father. I have HOPE that his PSA will go down. Do keep us informed.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
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