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Interpreting PSA Results

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User
Posted 22 Oct 2021 at 20:08

A year ago my Prostate Specific Antigen (PSA) Level was shown to be 25 ng/mL and I subsequently embarked on a course or Radiotherapy (20 sessions April/May) and Hormone Therapy (still on).  My latest Blood Test results show PSA is now at 1.9 ng/mL.

Getting PSA down from 25 to 1.9 is obviously good news, though I would have expected it to be 0.1 or something nearer this given that I am on Hormone Therapy!

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

User
Posted 22 Oct 2021 at 22:47

Hi John, that does sound quite high post RT/HT.... I was at 0.11 prior to my RT, which I have recently completed (after circa 9 months on HT), and will be having my next PSA test mid November where I would hope it would be a fair bit lower again. Have you had any comment on the PSA result from oncology yet ? Have you had other PSA tests post your RT as it was a while ago now ?
Cheers,
Nick

Edited by member 22 Oct 2021 at 22:52  | Reason: Additional info

User
Posted 22 Oct 2021 at 23:18

There isn't a good or bad PSA in your situation John; some people drop to below 0.1 while others stay around the 2 mark. The RT will carry on doing its stuff for about 18 months - that is when you are expected to hit your nadir (lowest PSA reading). You also started at quite a high reading and different HTs bring the PSA down to different levels. If your PSA rises over the next couple of tests, the onco will be more concerned but if it drops or stays where it is, I don't think you should worry yet.

When was your most recent decapeptyl depot - September? If you are worried, ask the GP practice to do a testosterone check with your next PSA - it should be at 0.69 or below. 

Edited by member 22 Oct 2021 at 23:21  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Oct 2021 at 23:30

Originally Posted by: Online Community Member

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

Hi John, have also had the same concern as my lowest reading on HT has been 1.49. Seems to hover between 1.5 and 2. Onco seems unconcerned as I still have a prostate so will still have PSA. Seems strange when some posters, as you point out, have seriously lower readings. 

Steve

 

Good luck to everyone coping with the insidious big C

User
Posted 23 Oct 2021 at 01:20
Some oncos don't like their patient to have a PSA test until at least 6 months after the final RT session. John had 3 monthly tests. I think because you are a bit concerned, another test in December would be a reasonable thing to ask for.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 24 Oct 2021 at 16:25

Hi

https://community.prostatecanceruk.org/posts/t23233-Brachytherapy---Radiation-buildup

I posted on this thread a while back. I hope it explains the 18 month delay.

Edited by member 25 Oct 2021 at 17:59  | Reason: Not specified

Dave

User
Posted 24 Oct 2021 at 17:15

Originally Posted by: Online Community Member

Thank you - but in what sense does it act over 18 months? i had imagined that the RT would attack the cancer cells and kill them off at the time of the fraction or shortly after. I am also imagining that with RT killing off cancer cells this reduces "supply" to the mets that will also be hit by the non-existence of testosterone and that is why the onco said no treatment, at this stage,  of the mets. I would have preferred to zap the lot at the same time. 

The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all. The cells don't die when they are zapped; the RT just damages their DNA so that they can't replicate.

I think that your imagining of what happens during RT is not how it really is. It isn't possible to lie on the bed while a machine zaps your prostate and then gives a couple of bones a quick shot as well. The onco takes measurements of exactly where the tumour is and then writes a computer programme specifying how much dose each tiny wave is to deliver and how deep - the programme can't deliver to two different destinations at the same time. The HT should be starving the mets. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 22 Oct 2021 at 22:47

Hi John, that does sound quite high post RT/HT.... I was at 0.11 prior to my RT, which I have recently completed (after circa 9 months on HT), and will be having my next PSA test mid November where I would hope it would be a fair bit lower again. Have you had any comment on the PSA result from oncology yet ? Have you had other PSA tests post your RT as it was a while ago now ?
Cheers,
Nick

Edited by member 22 Oct 2021 at 22:52  | Reason: Additional info

User
Posted 22 Oct 2021 at 23:18

There isn't a good or bad PSA in your situation John; some people drop to below 0.1 while others stay around the 2 mark. The RT will carry on doing its stuff for about 18 months - that is when you are expected to hit your nadir (lowest PSA reading). You also started at quite a high reading and different HTs bring the PSA down to different levels. If your PSA rises over the next couple of tests, the onco will be more concerned but if it drops or stays where it is, I don't think you should worry yet.

When was your most recent decapeptyl depot - September? If you are worried, ask the GP practice to do a testosterone check with your next PSA - it should be at 0.69 or below. 

Edited by member 22 Oct 2021 at 23:21  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Oct 2021 at 23:30

Originally Posted by: Online Community Member

Does anyone know whether this is a 'good' result or a case of 'could do better' ?

Hi John, have also had the same concern as my lowest reading on HT has been 1.49. Seems to hover between 1.5 and 2. Onco seems unconcerned as I still have a prostate so will still have PSA. Seems strange when some posters, as you point out, have seriously lower readings. 

Steve

 

Good luck to everyone coping with the insidious big C

User
Posted 22 Oct 2021 at 23:54
Thanks for all the feedback and advice, much appreciated. Picking up on questions in previous posts .....

This is my first PSA test post RT and I had to push for this to be done. How frequent should I be having regular PSA blood tests?

I have requested, but have not yet had, any comment on PSA result from oncology.

My most recent (and third) Decapeptyl injection was on the 27 August 2021.

John

User
Posted 23 Oct 2021 at 01:20
Some oncos don't like their patient to have a PSA test until at least 6 months after the final RT session. John had 3 monthly tests. I think because you are a bit concerned, another test in December would be a reasonable thing to ask for.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Oct 2021 at 18:32

When I was first diagnosed in Aug 2018, my PSA was 27 - following various tests, it was decided I had PC, a slow grower.

Eventually, I decided to go the HT RT route - started HT in May 2019.

RT was done oct - nov (20) 2019 My HT last dose took me up to may 2020.

PSA has been low at 0.05 last year  my latest one in may 2021 was 0.16 - Onco said all in line with expectations.

6 months is the normal time between PSA tests as far as I know, I will no longer have a 6 month consultation - just the PSA test. But if I have any problems, give them a call.

It took the best part of a year to get the HT out of my system & to get my "Normal" male feelings back. I have had more arm aches & pains since - but then I'm nearly 73 now!

User
Posted 24 Oct 2021 at 13:28

Lyn - what do you men when writing RT will continue doing its stuff for 18 months?

User
Posted 24 Oct 2021 at 15:53
RT has a long term action that continues for about 18 months
User
Posted 24 Oct 2021 at 15:56

Thank you - but in what sense does it act over 18 months? i had imagined that the RT would attack the cancer cells and kill them off at the time of the fraction or shortly after. I am also imagining that with RT killing off cancer cells this reduces "supply" to the mets that will also be hit by the non-existence of testosterone and that is why the onco said no treatment, at this stage,  of the mets. I would have preferred to zap the lot at the same time. 

Edited by member 24 Oct 2021 at 15:59  | Reason: Not specified

User
Posted 24 Oct 2021 at 16:25

Hi

https://community.prostatecanceruk.org/posts/t23233-Brachytherapy---Radiation-buildup

I posted on this thread a while back. I hope it explains the 18 month delay.

Edited by member 25 Oct 2021 at 17:59  | Reason: Not specified

Dave

User
Posted 24 Oct 2021 at 17:15

Originally Posted by: Online Community Member

Thank you - but in what sense does it act over 18 months? i had imagined that the RT would attack the cancer cells and kill them off at the time of the fraction or shortly after. I am also imagining that with RT killing off cancer cells this reduces "supply" to the mets that will also be hit by the non-existence of testosterone and that is why the onco said no treatment, at this stage,  of the mets. I would have preferred to zap the lot at the same time. 

The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all. The cells don't die when they are zapped; the RT just damages their DNA so that they can't replicate.

I think that your imagining of what happens during RT is not how it really is. It isn't possible to lie on the bed while a machine zaps your prostate and then gives a couple of bones a quick shot as well. The onco takes measurements of exactly where the tumour is and then writes a computer programme specifying how much dose each tiny wave is to deliver and how deep - the programme can't deliver to two different destinations at the same time. The HT should be starving the mets. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 24 Oct 2021 at 21:59

RT has been developed now that can deal with mets in Lymph nodes.

Port Macquarie, Australia

I hope that this will be available world wide as soon as possible. It was the treatment I received.

User
Posted 24 Oct 2021 at 22:40

The article doesn't say what the treatment is.

If it's SABR/SBRT/Cyberknife, then that's been available here in specialist centres for a while now. On the NHS, you can have up to 3 mets treated in this way. Any more than that, and the treatment doesn't work because you probably have many other micro-mets too.

Alternatively, it might be referring to whole pelvis or prostate and nodes EBRT. That's been done here for a long time.

User
Posted 24 Oct 2021 at 22:46
My RT is directed at prostate plus lymph nodes.
User
Posted 24 Oct 2021 at 22:47

Originally Posted by: Online Community Member
The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all.

Zapping the cancer cells in the prostate does slow down the progression of early mets elsewhere. Some patients with small numbers of mets are now being offered prostate radiotherapy early on to extend life. More recently, there's also been a trial of prostatectomies for the same reason (TRoMbone), but results not yet available for that.

It's thought that the mothership cancer helps support the initial mets to grow with release of chemicals.

User
Posted 24 Oct 2021 at 23:23

Andy, I'll see if I can find you a better/more scientific article on the process but the essence is that it's possible in one treatment to specifically target both the prostate and lymph glands, without blasting the whole area with radiation.

Your posts on diet and body composition scales were most interesting. I'm going to post something on that shortly.

User
Posted 24 Oct 2021 at 23:27

Originally Posted by: Online Community Member
My RT is directed at prostate plus lymph nodes.

 

Yes; lymph nodes close to the prostate ... they wouldn't be able to zap lymph nodes in your chest at the same time as your prostate. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 24 Oct 2021 at 23:33

I don't want to divert the thread away from its original purpose so I'll keep this brief. Here's a couple of references:

targeted radiotherapy

 

external beam therapy

 

Jules

User
Posted 24 Oct 2021 at 23:39

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
The prostate cancer cells in the prostate aren't travelling backwards and forwards to the mets so the radiation to the prostate has no impact on the mets at all.

Zapping the cancer cells in the prostate does slow down the progression of early mets elsewhere. Some patients with small numbers of mets are now being offered prostate radiotherapy early on to extend life. More recently, there's also been a trial of prostatectomies for the same reason (TRoMbone), but results not yet available for that.

It's thought that the mothership cancer helps support the initial mets to grow with release of chemicals.

TRombone has been running for years and we have a few members here who have either had RP or radical RT knowing that they were metastatic. My point was that RT to the prostate may slow down the development of new mets but is not going to kill the cancer at existing metastatic sites. No one is claiming that RP or RT to the prostate is potentially curative when mets are already known. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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