It's doubled in twelve months. Although in absolute terms the increase is
not much, it seems to me to require an explanation.

I note that Mike refers to his unconcerned *urologist*. A urologist is a
surgeon and IMO has no legitimate function in tx that does not involve
surgery. I most urgently recommend consultation with the radiation oncologist.

This has the distinct aroma of systemic PCa. Consultation also with a
medical oncologist would not be inappropriate.

Lastly, refer to the website of the Prostate Cancer Research Institute at
http://prostate-cancer.org/index.html for objective and authoritative
information. This is indispensable if Mike wishes to empower himself and to
be an active participant in tx decision-making.

Regards,

Steve J

"We must tailor the treatment to the nature of the disease. We must listen
to the biology."
-- Stephen B. Strum, MD

My understanding is that this result is not yet identifiable
as a problem.  So far, I agree with your urologist.  What you
are seeing is indeed normal.

Seed implants are known to frequently cause PSA bounce for
up to three years.  During that period, the PSA can rise
and fall.  The reason generally given for this is that
radiation does not kill all of the prostate tissue outright.
It damages it and makes it difficult for the cells to divide
and replicate - which is required for cancer to progress.
In the meantime, you still have a prostate and, for most
men, you still produce some PSA.

Some men experience PSA bounce for even more than 3 years.

For unknown reasons, men who have brachytherapy apparently
have a much higher incidence of PSA bounce than men who have
IMRT alone.  But it is NOT evidence of treatment failure.

For your next test, abstain from sex, serious exercise,
bike riding, and anything else that could stress the prostate
for at least 3 days before the test.  I'm hoping you'll see
the PSA stay the same or go down.

My own PSA has bounced around pretty wildly after EBRT and
HDR brachytherapy - with a high of 1.8 and a low of .5, with
.6 as my last reading.  I and my doctors (at a National
Cancer Institute clinical trial) were alarmed by the 1.8,
but when they saw the next one was .5, they decided there
really is no evidence of disease progression.  They have
seen some PSA readings in the trial that were even higher
than mine that came down again.

My first PSA coming out of treatment, after the Lupron wore
off, was .8.  Then IIRC: .6, .9, .8, 1.8, .5, .6.
Personally, I'd be thrilled to have a PSA as low as yours.

I know you're sweating about this one.  I don't blame you.
But so far, I think your doctor is right and the chances
are that you have NOT failed treatment.  For comparison,
one guy on this group who did fail radiation treatment had
a PSA after treatment of 3.something, then went to 12, then
to 24.  He's now on hormone therapy.

In your case I think it would be a big mistake to go on
hormone therapy yet.  First off, you probably don't need it.
Secondly, if you do have recurrent cancer (unlikely) you
still don't need it yet.  And thirdly, it will lower your
PSA to undetectable, making further evaluations of the
radiation treatment impossible - PSA will no longer be a
useful measure of where you are.

One of the advantages touted for RP over RT is that the
surgery patients have a more reliable measure of whether
their treatment succeeded or failed.  For some people this
is essential.  They can't stand the uncertainty.  But those
of us that chose RT have to just be prepared to deal with
this uncertainty and not let it overwhelm us.

Stay cool.  I think you're most likely to be okay.

   Alan

It might be that your PSA is doubling every 6 months.  Your next one will
tell the tale.  As with several of us, your "proof" is just on the cusp and
your doc is suggesting you wait for another PSA to see if if levels off.
Unless you can shut it out, I am afraid you're in for three months of
hand-wringing.