PSA Changes – Post Therapy | ProtonPals

Prostate-Specific Antigen (PSA) Test

There was some discussion of PSA results at the January 23, 2008 support group meeting. In responding to questions, Dr. Lee said, there’s no absolute number that one should look for in post treatment tests and having a high PSA is not specific to cancer. There are many things that can cause PSA levels to increase as indicated in a table below. He also pointed out at the meeting and to many of us privately, he’s never known anyone to die from a high PSA reading. It’s a biochemical indicator of what’s going on but one reading does not tell the whole story. Here are a few words explaining of why the readings need to be interpreted by an expert preferably an genitourinary oncologist.

A PSA test measures the level of an enzyme in the blood produced by the prostate gland. Most of the PSA is in semen and normally only a small amount escapes into the blood. Although the test was developed for initial screenings it is also used to follow the state of the cancer post treatment. The test has limitations and like so many tumor serum markers, PSA is not specific to cancer and produced by both normal and cancerous glands. Large glands produce more than small glands. More specific (molecular) tests are being developed and although none are in general use in the Fall of 2011. Again it is not an absolute indicator and every man will respond differently to treatment and recovery. Remember the saying “there’s no average patient”.

If you have prostate cancer, your PSA score by itself is often not a very accurate indication of your condition before you begin your primary treatment, whether you have proton therapy, seeds or surgery. By contrast, PSA readings taken after your primary treatment are frequently highly indicative of whether your treatment is successful or not. That is why your doctor will want you to have your PSA taken every three months for a year or two after treatment.

What sort of PSA readings indicate that your treatment has been successful? Obviously, if you never had hormone therapy and your PSA reading is say, less than 1 ng/mL at your first three month checkup after treatment, that is very favorable. You’re doing great if every one of your 3 month check ups produces a PSA of less than 1. But many, perhaps most of us do not have a PSA that drops right to the bottom after three months and stays there.

So what if your PSA does not drop very much at your first 3 month check up? What if it actually goes up at your first check up? What if it bounces up after 3 months? Does that mean your proton therapy was a failure? Not necessarily.

Readings 3 months after treatment rarely if ever is conclusive. By itself, it means very little. Instead, your doctor will look at your first three or four PSA readings to determine if there is a trend or a pattern of PSA readings. Let’s take a look at some of these patterns.

The first slide depicts the median patterns of a group of men following their treatments at the University of Florida proton center during the first two years. PRO1 is the low risk group, PRO2 is the medium risk group and PRO3 is the high risk group. See how gradual the patterns are over the first two years after treatment ends (the line marked RT end). The exception is PRO3 the high risk group because they’re put on hormone therapy at the end of their treatment, so their PSA drops much faster.

The second slide shows a big jump in the first 3 months, and then an even bigger drop at the six month reading. As long as the pattern drops

The result of treating the prostate cancer you should see the PSA and in the initial 2 years in recovery readings are usually taken every 3 months by your oncologist. You should see a reduction in PSA in the first and subsequent tests, and for example in some men the PSA scores at diagnosis are reduced by half at the three month time frame and at others by a larger fraction. The PSA should continue to fall over a period time until it reaches its ultimate lowest point called the nadir. The PSA at the nadir in some cases is undetectable and that’s a good thing and if it stays at that low level that’s also a good thing. The time to a nadir can take up to 24 months or longer and the change in PSA is a gradual process . Once the nadir is reached, a low and non rising PSA will define disease freedom.

For men with hormonal treatment the PSA levels discussion will be entirely different. As of this writing the only data we have are the anecdotes from patients who write back to us. It appears that the PSA levels are reduced in a matter of weeks to nearly undetectable levels by the Lupron shots, for example, less than 0.1 ng/mL. When the hormone treatment is complete the PSA may gradually rise over the weeks after treatment and then level off over the next 18 months. See the results from the men below.

Results will vary from laboratory to laboratory

Different PSA assays (analytical processes) give different results on the same blood sample. This is an obstacle to recommending uniform PSA limits for prostate biopsies. Therefore, if you have a PSA test done in one lab, it is quite possible that another lab may give you a different reading which could vary by up to 20 to 30 percent; especially important if your assay is at low levels, like 0.3 ng/ml. If you’re not traveling to Houston for follow ups with the oncologists at M.D. Anderson, you may want request a kit that you can use to have your blood sample shipped to the center in Houston for consistent analysis.

PSA results will be elevated by exams or having sex

Sexual activity, an infection of the prostate, pressure on the groin or rectum can elevate the PSA. Sources vary as to how long a man should abstain from sex, bicycle riding, horseback riding, etc. before having his PSA level checked. Three days (72 hours) seems reasonable. If your follow up visits not being done at M.D.A. by Dr. Lee, Dr. Choi, or Dr. Pugh insist that your blood be drawn for PSA level before your DRE is done.

Condition/Manipulation	Effect on PSA Increase	Persists
Acute bacterial prostatitis	5-7 fold	6 weeks
Acute urinary retention	5-7 fold	6 weeks
Exercise – bicycle	0-3 fold	1 week
Prostate Biopsy	Very variable	6 weeks
Prostate Massage	Variable	6 weeks
Ejaculation	Variable	3 days
TURP	Variable	6 weeks

Source: Published in the August 1998 Journal of Laboratory Medicine and from page 190 Robert J. Marckini’s book, “You Can Beat Prostate Cancer and You Don’t Need Surgery to Do It”. http://www.prostateawarenessfoundation.org/faq-diagnosis.shtml

Please send us your input. Send your reply to Ban Capron bancapron@hotmail.com or if you receive this by e-mail simply click reply to Joe Landry. We are looking for comments on how you function either during treatment or well after. You can provide “your first name, e-mail address (optional) and completion date” or say “anonymous and completion date”. Also indicate if you had proton radiation only (P) or proton and hormonal therapy (PH). Always put your completion date. Please be brief.

PSA Trend after radiation without hormonal treatment

My 9 month PSA test was 0.2 (Hooray) and everything is great here in Iowa. I received my last treatment at the proton center on Old Spanish Trail in August 2006. I miss the great people that helped me and know they are doing good things for the men in treatment now. Please forward to all graduates and those in treatment. Stay the course, keep the faith – proton therapy WORKS. Life is good. Best Regards,

Tom B (P)(original patient #7)

I did not have the hormone shots. My PSA was not elevated. It was a 0.6 when my urologist did an exam and felt a major change in my prostate. He recommended a biopsy and bingo, a life changing event began. My first follow up exam and blood work revealed that my PSA dropped from a 0.6 to a 0.5. I was disappointed because my friends had a much more significant drop percentage wise. I have just sent in my blood serum for my next PSA blood test. Dr. Lee has made it clear to me that each man is unique when it comes to PSA production. Blessing Tommy (P) Completion Jan 2007

Hope everything is going well for you. Let me know what you find out at your 3 month checkup. I had mine about 2 weeks ago and PSA was at 2.4, down from 6.7 at time of treatment. Dr. Choi was happy with my number, so I guess I should be also. In 6 to 9 months, it should be under 1.0 Bedford (P) completion April 2007

Just had my first check up on Friday 2/15/2008. My PSA has dropped from 6.7 prior to treatment to 1.0. I have had no major side effects. Dr. Choi was very pleased with my progress. Don (P) November 2007

I can’t say I know much about this yet other than the lab in Dallas read my PSA at 6.2 prior to treatment and a few months later M. D. Anderson had my PSA at 3.9 just prior to treatment. It seems having M. D. Anderson do all our readings is important.

Ban (P) Completion February 2008

PSA Trend after radiation with hormonal treatment

I, too, am doing really well. My nine month check showed my testosterone nearly back to where it was before I had the Lupron shots (300+). My PSA has gone from <0.1 to 0.5 to 1.12 after nine months. Dr. Choi says it is not uncommon to see the PSA increase as the testosterone recovers. Ken (PH) completion April 2007

Wanted to report my three month findings. My follow up was on Wednesday, 11-21-07. PSA 0.1 – Testosterone 26 – Normal 240-800 – 4/07. Initially testosterone (T) reading was 332, Dr. Choi tells me it will be 2-3 months before the T begins to head back to normal. Also, my PSA should rise during this time then level off. I am told not to panic in the next year and a half while the PSA stabilizes.

James (PH) completion August 2007

As a PC cancer patient, I choose androgen deprivation therapy (ADT) over the other treatments. I can state with some authority that the ADT does lessen your libido as well as erectile dysfunction (ED) to a great degree, but the article did not state that it is reversible, where the other treatments are not. This is a very important factor when deciding which treatment to select. I can only speak for myself, but when the cancer is caught early and, is considered low grade, then this treatment should be given serious thought, as it can be done intermittently, so there are long periods of normalcy, and also you are intact as a male, without the irreversible side effects, which were stated in the article. Just treat it as a chronic disease for the rest of your life. The article was very informative. Robert (PH) of CA

I finished treatment on Aug 2 2007 PSA has been LOW. I see my urologist about every 3 months. He had started me on hormone treatments before I went to M. D. Anderson. Those treatments reduced my PSA significantly. I feel like the hormone treatment effects are just recently wearing off. (8 months since the last 4 month shot)

Lee (PH) completion August 2007

Added Section - PSA Trend after radiation without hormonal treatment. It had been a year since my last PSA test where my level was 0.3 and I was a little apprehensive when I went in on Monday Oct 19, 2009 for what has become an annual check up. Hooray, it was lower than last October, rocking along the bottom here at what I learned was a “nadir” of 0.2 ng/ml. I’ve included my chart as an example of post treatment trends for patients from the MDACC treatment center. I had BPH like urinary issues when I went in for treatment and still have them. These I manage by taking Ibuprofen and cranberry capsules and taking Flomax as medication. The chart is updated for an April 2011 follow up at the 4 year anniversary.

Joe (P) completion April 2007.