PSA what should I expect

Hello ValBe85458 

My understanding is you reach your nadir (lowest) PSA 18 months after you have completed radiotherapy.

After that point intervention would be considered necessary if:

* Your PSA rises to 2 whole points above your nadir or

* You have 3 consecutive rises in a row.

Don't forget we are all different and consultants have their own views. I had 3 years HT - my PSA started rising my 3 monthly tests were 1.63 and then 3.86 - my consultant and me agreed intervention when it went to 10 or above - the next test was 27.5 ! I am now back on HT!!!!!!!!

Do let us know how you get on.

Best wishes - Brian.

Thank you. Now you are clearly more knowledgeable than me but I never realized that the Nadir was 18 months after radiation ends. I always believed it to be the lowest point reached after ADT started. In my case I have no doubt that 0.25 was the lowest point that I reached and I have no doubt that now that testosterone is returning it will go no lower. I remain optimistic but with high grade one feels destined for an inevitable return. I view the blighters as invaders and wish to keep them at bay for as long as possible. I am very sorry to hear of your situation and it's disappointing that you experienced such a swift rise after 3 years of treatment.   

Hello ValBe85458 

It's all part and parcel of the journey for me, I am a bit of an "oddity" as I started my journey with a PSA of 182 and no spread (you can read the journey details by clicking on my name or avatar).

I knew I would be back on treatment as I completed the 3 years last December and the old testosterone was back by February as everything was working and very well! .

Do keep us posted as to how you get on with your Consultant.

Best wishes - Brian.

Hello ValBe85458 Just to add onto Brian's reply - the nadir after radiotherapy is usually considered to be at 18 months but can take as long as 3+ years. Also there is a phenomenon called the PSA bounce which can occur when there is a temporary rise at some stage after either radiotherapy or after the end of hormone therapy and is typically in the order of 0.3 to 0.5. The experts will probably do a repeat test to check whether there is a bounce or a recurrence. If it is a bounce then the PSA should stabilise or go back down to establish a new nadir. If it is a recurrence then the PSA will increase at which time it is the rate and extent of the increase along with scan results which will determine what the next steps are.

Let us know how you get on.

Oh my goodness, sir—you really are a mine of information. I had no idea PSA levels could climb that high. You also have a remarkably philosophical approach!

I went for my test yesterday and the result was 0.97. The doctor said it was what he expected and advised that we simply wait and see. Being optimistic, I was relieved it hadn’t risen even more, though to my uneducated eye the trend still feels rather quick: 0.25 in February 2025, 0.58 in September (not August), and now 0.97 in December. I suppose the real test will be what happens over the next two three-monthly readings.

What did surprise me was the consultant saying that there would be no PSMA scan until the PSA is above 2. From what I’ve read, I had the impression it was usually done earlier than that.

Thanks for that. While I was on ADT, my PSA flatlined at 0.25, so I’m accepting that as the nadir. I really appreciate your comments—they’re helpful and insightful. The main thing I took from my visit yesterday is that you just don’t know which way the river will meander.

Good Morning ValBe85458 

Thank you for coming back to us with details of your visit to the consultants yesterday - yes your PSA is rising but very slowly. Your Consultant has your back here so don't worry, enjoy Christmas and the New Year and lets see what your next test brings.

The issue with a PSMA-PET scan is yes it can detect cancer with a PSA as low as 0.2, it works best when your PSA is around 2.0 (oh! and the cost to the NHS of each scan is around £2500.00!!).

As to the "game" of PSA "Top Trumps" I am way down the list at 182, we have Community members who have a PSA in excess of 4000!.

Do stick with us and ask any questions.

Best wishes - Brian.

I THINK that there is potential danger in over focusing on PSA numbers, especially if recurrent. To have the metastatis identified by my PSMA PET scan would normally be linked to a PSA of >10. Mine was 2.9 before referred back to Oncology (only because I read the result rather than relying on GPs "normal, NFA") and rose again to 4.5 while waiting to see Consultant. 

1 mth of standard HT+ dropped it to 0.95. More important I think is that testosterone level fell very rapidly to a perfect 0.7!

Low psa, high grade, cancer is relatively rare but mocks standard treatments!

Dave.

Dave 

I beg to differ. PSA (prostate-specific antigen) is one of the most significant and reliable indicators for detecting prostate cancer recurrence after treatment. While its interpretation varies slightly depending on the type of treatment a patient received, PSA remains central to follow-up and long-term monitoring.

PSA is widely regarded as the single most important marker of recurrence because it:

• Is highly sensitive

• Detects recurrence early

• Guides further testing and treatment decisions

• Provides additional prognostic value through PSA kinetics (rate of change)

Hello Dave (Carl28 (5aa97c53920c4078aa11fdbc45285983)) 

Sadly at present PSA is the only reliable indicator of any increase or decrease in Prostate Cancer. It's only a guide BUT it's all we have.

Take me - i am an "oddball" initial PSA of 182 and no spread (I need to buy a lottery ticket!).

I am under The Christie in Manchester and the 4th ranked best cancer hospital in the world - they use PSA numbers to check your progress or lack of it.

Best wishes - Brian.