Slight increase in psa level, after finishing external beam radiotherapy

Hi Alwayshope,

I finished RT in April 22 , my Nadir was 0.34 now it’s up to 13.26 , I have had 2 pet scans that came back clear .

my nurse said it’s rare that nothing is showing, I was wondering and I know this may sound daft, do micro cells find each other to cause recurrence , or is this just a  figment of my imagination.

Best Wishes

Tony

Hello Tony. I think what you are asking is could the rise in PSA which you are seeing be due to many micromets which are too small to be picked up by the PSMA PET scan which would give you a false negative? Very unlikely. The main reasons for a false negative are either a failure of the tracer preparation or human error in reading the scans. You are being treated at a centre of excellence which has been dealing with this technique for a while and will have all the checks and balances in place to minimise any errors. The fact that your PSA is being found in the blood means that something is producing it and there is about a 95% accuracy with the PSMA PET CT at the level of PSA you were at when you had the last one. The one negative with the scan is that it doesn't pick up the rare non PSA secreting prostate cancers which are usually picked up by the prostate biopsy or can result after prolonged ADT treatment. When my husband had his scans they covered from the top of his head to half way down his legs as these are the area where the cancer can possibly migrate to so they are normally pretty comprehensive.

Your situation has been unusual in that the ADT produced sub optimal castration with a slow PSA decline which is one of the markers for potential recurrence, as is the Gleason 4+3 and your initial PSA, plus the rate at which it is now doubling. In your profile you say that you were having Prostap injections for 2 or 3 years so by now it should either be out of your system or starting to come out which can increase the PSA, as can the regrowth of the prostate tissue but not to the level that you are experiencing. I would think your concern is 'what next'? It would have been nice to know where the cancer so I presume they will have another PSMA PET CT scan but there are still options for dealing with it if that one comes out negative. Don't forget that you are being treated by a very experienced team who have access to all the latest knowledge and techniques.

Please keep us updated as it helps all of us learn when things don't follow the normal pattern.

Hi Alwayshope,

Thanks for reply , 

I asked to go back on HT to try to control the rising PSA, the doctor said that’s fine however we would need a scan before we do that , or we can wait til after Xmas , do BT and if PSA reaches 20 scan then .

I’ve been feeling well so I decided to wait.

Thanks again best wishes

Tony

Hello Always Hope (but if I may I will call you AH as it sounds so much less formal lol)

Thank you for finding this article (most of it is way beyond my comprehension), but your final paragraph covers the original question nicely.  

Once again, your detective skills have shone brightly.  

Best Wishes

Brian