PSA levels after salvage radiotherapy

Hello to all out there

I finished salvage radiotherapy to the pelvic bed on November 18th (35 session over 7 weeks of 70 Gray)

My original operation (radical prostatectomy) had been in February 2020 and original post op PSA was 0.09 which unfortunately went up to 0.20 by August .

I had not done adjuvant therapy as it seemed to me better to heal the wounds of the OP.

As I have Gleason 9 ,RT was rapidly initiated in September at PSA level of 0.21.

PSMA scans were clear but they show little at such PSA levels.

I just did blood tests yesterday and PSA is 0.07 .

This is two months after finishing RT.

Does anybody on this forum now when the lowest PSA would be measured after salvage RT?

Also is this considered an acceptable result ?

I will consult the urologist and oncologist next week but am not totally pleased had hoped we would go to zero PSA.

I do hear that sometimes the nadir is reached slightly later than two months after RT,does anybody here have experience of that?

I had some side effects for continence but they are largely ok now digestion was slightly disturbed for a while but not too bad.

I am worried as my white cell count is low (3700) and my ferritin level is low (27) and also have low lymphocytes (800) so immune system is not at best level.

Hematologist says though my blood levels are acceptable.

I realise that the prostate cancer is really very difficult to figure out at any given time as there are so many different types of recurrence.

This is still a BCR  measured by ultra sensitive tests but one wonders where it ends.

But main question is does anybody know when nadir is normally reached.

All the best to fellow sufferers and family of the patients.

Keep as safe as possible.

  • Hi Troc

    PSA nadir can take up to 1 year and beyond. Two years after my RT the PSA was and still is going down albeit slowly.

    So as your RT has only just finished give some more time, anyway .07 is fine. Are u still on hormone treatment because that will affect the result?



  • Hi

    I refused hormone treatment as my Austrian  Professor asked me "Please do not do hormone therapy"

    Hope he is right

    how are you in the meantime

    all the best


  • sorry how was yours straight after if I may ask?

    all the best


  • Do you know why your Austrian professor asked you not to do hormone therapy?

    My blood tests are not to the same accuracy <0.1. Therefore most places would consider 0.07 as undetectable.  I do hope  that your bloods will continue to remain low.  I’m doing hormone therapy which also drops the psa

  • Hi Troc

    My PSA was 1.33 6 months after   in 9/17 and .55    3/20.

    Surprised  u didn't have hormone because the surgery hadn't worked but in the event it looks like the RT has worked.

    Fingers crossed similar result whenever your next PSa test happens.

    All the best


  • Thank you for your wishes and hope you are also lucky

    He is a very well known Professor doing new therapies.

    He does the Luthetium 68 therapy if cancer is castration resistant.

    He says the hormone therapy changes the molecular structure of the cells.

    The percentage improvement is about 8 per cent with hormones but if it restarts thats it then you have problems.

    My problem started probably because I took finisteride to reduce testosterone.(psa is too low due to this drug you must double the tested  level:so psa 3 is in reality 6!!! ) two doctors missed this!!!

    I realise that the HT may reduce PSA but even Munson and Walsh say it is not clear if the result is worth the side effects.

    I feel I have enough side effects after radical prostatectomy etc.

    I have read so much and you cannot read enough...but its disturbing as the docs dont agree!

    I wish you the  best and there is a lot of luck in all this,my wife survived one of the most aggressive cancers for 8 years .

    Her chances were given 15 per cent survival for one year....

    So be positive but there are good doctors and mediocre ones like in all professions.

    so try look around

    all the best


  • Well lets hope we survive for many years

    thanks for your help

    all the best


  • Troc

    Interesting your piece on HT. I have always thought that with a low PSa and Gleeson and tumour well contained why go thru the hassle of having HT. 

    Why not save the HT in case u need it later?

    Unfortunately it seems to be standard to give the HT these days .

    Obviously different if you have an aggressive cancer about to break out.


  • well mine is aggressive as Gleason 9 but the opinions were split.

    HT is standard but 3 urologists said save the HT in case it comes back.

    You cannot see lesions with PSA of 0.07 on Pet Psma but if you use the hormones you do decrease the PSA but you do not know for how long.

    If cancer then reverts it can be much worse.

    There are so many people with Prostate cancer and so many studies but the opinions can vary a lot.

    I made my choice and will now hope that this is over.

    Chances of recurrence with Gleason 9 are still around 40 per cent.

    all the best


  • Roy,  I think that a Psa of .07 after all u have been thru is amazing especially without HT.

    Lets hope that it stays there and if it does raises a lot of questions about the use of HT and all the problems that it can cause..

    best wishes