Prostate Cancer reoccurrence after RT

I would agree with your oncologist: as your testosterone returns, your surviving prostate cells are recovering and producing PSA again. what type of radiotherapy did you have?  The standard 60gy EBRT?  Or brachytherapy as a mono therapy?   AW

Hi LogsB .

At the moment you could be having 2 things going on at the same time. The testosterone is recovering, as are you good prostate cells which can result in a new baseline PSA. At the same time there is a phenomenon called the PSA bounce which can occur around 12  months after the end of radiotherapy, particularly in younger men and those who have had either Brachytherapy or SBRT. Things should settle down after about 18 months when all the debris from the radiotherapy has been cleared out your body by the lymphatic system. It is too early to ask for something like a PSMA PET scan as the radiotherapy is still working and residual dead cells in the prostate could still show up and result in over treatment.

I had External beam radiation last November after T-Blockers. I presume it was all standard procedure.

My 'Bounce' seems to have occurred after 3 months rather than 12 and is actual a ramp, at the moment increasing by 0.4 every three months. I am told if it get to 2 then I will be called in again by Oncology for investigation. I have no idea if this is true or not, does cycling increase one's PSA count? I cycle to my blood tests, about 4 miles. Maybe this is giving me false readinsg?

My father finish Rt 05.2023 GS 3+4

Psa:

07.2023 0.03

12.2023 0.09

04.2024 0.15

07.2024 0.2  MRI, bone scan all free

12.2024 0.19

Hello again LogsB .

There are different thresholds of PSA warranting further investigation after primary treatment of either prostatectomy or Radiotherapy so for radiotherapy it is normally a PSA of 2 above your nadir (lowest level). The rate of increase is also looked at. Do you know whether the radiotherapy was just to the prostate or was the whole of the pelvic area including the seminal vesicles and lymph nodes treated? This is my understanding of what is going on but remember that none of us are medically trained. When you have radiotherapy the cancer cells are usually given an extra zap to make sure that they cannot multiply and survive but the surrounding tissue is given a lower dose which means that it can recover after a period of time and in the case of the prostate this can result in an increase in PSA. What the experts have to decide is whether any increase in the PSA is due to the natural recovery of prostate tissue or whether there are still cancer cells present. Also you say you have been on testosterone blockers which I presume was hormone therapy. Different types of hormone therapy work in different ways and can remain in the system for different lengths of time. These hormone therapies stop testosterone production but can also result in a drop in PSA but once you come off them the hormones can start to recover and at the same time might result in an increase in the PSA to a low level and contribute to the ramp that you are seeing. Anything which stimulates the prostate such as ejaculation within 48 hours of the blood test as well as cycling can raise the levels in men who still have some prostate tissue.

Hi LogsB, not spoken before but if it helps, my Oncologist told me to avoid cycling as this would irritate my prostate and given I had an aggressive tumour ( Gleason 4+5) could make initial treatment problematic, whatever that meant, notwithstanding this he encouraged me to use a recline bike in the gym as a means of good exercise to help with fatigue.  My PSA has fallen like a rock but did spike as a result of EBR   I’m due another PSA test early Jan with a post RT review late January so won’t get a proper picture as to my progress till then   All the best for the season, I’ll keep my fingers crossed for you and a favourable outcome 

Many thanks for the replies.  Though my December PSA had reached 1.1. A month before I had a bone scan which showed all clear. I am told my external beam RT was for the prostate plus a bit extra for the prostate gland bedding. My Lymph nodes were not zapped as they showed all clear. And, given only one biopsy core of 17 showed cancer and the MRI showed it was grade 2, I am thinking maybe I am worrying over nothing. From responses above it seems the prostate recovers, T-Blocker (zoladex) wears off which could explain the PSA score. I did not know any of this. I am interested to explore more about cycling so would appreciate any input. If this raises PSA am I correct or not in thinking this does not exacerbate cancer? I am a keen cyclist and contemplating an 800 mile trip from London to Geneva in the summer.

Hi LogsB .

Keep cycling, it's good for you. There has been research to show that the benefits far outweigh the negatives and after treatment you are at less risk than a man who does not have prostate cancer.

https://www.cyclingweekly.com/fitness/essential-guide-to-prostate-health-for-cyclists-234445

I don't know whether it would be worth investigating prostate friendly saddles.

Are you intending to combine the trip with charity fundraising as PCUK and Macmillan might be able to help with this.

https://www.macmillan.org.uk/fundraise/fundraising-ideas/physical-activity/your-cycle

Some places include Testosterone level with PSA tests when you stop hormone therapy, until your Testosterone has returned to a stable level. This is useful because you see PSA rising about 3 months behind Testosterone, and then you know it's the expected pattern. It's also useful for the patient to know how their Testosterone recovery is going. If PSA continues rising some time after Testosterone levels out, then that would be more worrying.