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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Answering Concerns About Monitoring for Cancer After Radiation

Hi again,

Here are some thoughts about your post just today, interspersing your concerns:

[QUOTE=efang;5488517]Someone told me about disadvantages of radiotherapy,
she said after Radiotherapy , you can’t do the biopsy for that dead prostate ,( Why?)[/QUOTE]

[COLOR="SeaGreen"]You can't do a biopsy within two years of doing radiation because the radiation will have wiped out all the cancer in the prostate and capsule. Actually, much of the prostate tissue is not dead; healthy tissue often survives the radiation, and that healthy tissue often produces a small amount of PSA. There can even be a prostatitis infection or harmless immune reaction that affects the PSA level in a well-radiated prostate.[/COLOR]

[QUOTE=efang;5488517]PSA will gradually decline after therapy , and finally to the base value, and everyone is different.[/QUOTE]

[COLOR="seagreen"]That base value, the low point for PSA after treatment, is called the "nadir." The decline is what you want, and it may happen pretty quickly, or more gradually. This is not in any way a disadvantage but is rather just the way radiation works. While it is true that there is not a universal pattern for PSA decline after radiation treatment, the vast majority of us have declines that fall into well-recognized and understood ranges, and it's not that hard to spot cases where there is metastasis that hasn't been cured or ineffective radiation to the prostate.[/COLOR]

[QUOTE=efang;5488517]Late there may also be a rebound PSA , which is not easy to distinguish from recurrence or other . because the prostate is still there, it is difficult to determine whether it is the recovery of normal tissue or cancer recurrence. Really?[/QUOTE]

[COLOR="seagreen"]That rebound, which some patients do experience, is often called a "bounce" when it is not a recurrence; the PSA goes up a bit - perhaps for a couple of months but even for a year or sometimes longer, then drops down again and stays down, more often after radiation with seeds than with external beam. A bounce in PSA is not in any way a sign of recurring cancer, but, before the PSA comes down and you know that the increase was just a bounce, it is, naturally, a concern to patients. But it helps when patients learn the facts about bounces so that they are not overly and unnecessarily worried.

Researchers and doctors are not completely sure why it happens (in about a third of patients - considerably more than a third for patients who had seed therapy, and considerably less for patients who had external beam) - likely an immune response in the prostate or prostatitis, but they do know the typical timeframe after radiation during which it happens - 1 to 3 or 4 years, and the likely ranges of a bounce - from .2 to even 10 (in rare cases), but usually about 1. I've had friends who had late bounces, around 4 years as I recall, and bounces of several PSA points before they declined. I had no bounce from my very low nadir of less than 0.05 (highest value seen with a more sensitive test was 0.02) after my IMRT external beam radiation in 2013, but the absence of a bounce is more likely when the patient's testosterone is low, as mine is.

Research suggests that patients who do experience a bounce tend to do a bit better than those who don't in the long term.

One clue whether the PSA increase is a bounce or a recurrence is the original presentation of the cancer: if low risk (Gleason of 6 or lower, PSA of 10 or lower, and stage of 2 or lower), an increase after radiation is more likely to be a bounce compared to increases for men with higher-risk cancer. The society of radiation oncologists has a guideline that a persistent increase in PSA of 2 or more above the PSA low point is a recurrence, but that is not always the case. That guideline is pretty good at distinguishing bounces from recurrences.

The pattern of PSA results is also important. A steady doubling of PSA - the tell-tale "exponential" pattern of increase typical of cancer- would also be evidence suggesting a recurrence, while a zig-zag, up and down, oscillating pattern would suggest a bounce. Doctors I follow recommend monthly PSA monitoring when a PSA increase is experienced after the nadir following radiation. If there is reason for concern, a highly sensitive scan could be ordered to resolve the issue.

The bottom line here is that there is no "certainty" in determining a bounce from a recurrence, but (1) two thirds of us will not experience a bounce, (2) there are good clues as noted above, and (3) even if there is a recurrence that is caught a little late, there are very good ways of dealing with it in a timely, early way that is most effective against the recurring cancer.

One semi-final thought: imaging with scans is now highly effective, and it is now possible to use advanced scanning to find small metastases from recurring cancer after radiation. At the moment that is probably going to be considered not worthwhile for many patients, but this could change, and as of today such scans are available and probably a good idea where there are clues suggesting a recurrence rather than a bounce.

A final thought: your concerns are worth thinking about, but none of them is that important as a disadvantage of radiation compared to other therapies, particularly surgery. I hope this helps.[/COLOR] :wave:

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