On Nov 15, 4:22 pm, "3Putt from CoastalSouth Carolina"
<3putt@PawleysIslandSC> wrote:

My PSA bounced around like crazy.  It was held artificially low
by HT for the first few months, then it went up to .8, down to .6
up, down, up down, then gradually settled down.  My highest reading
was 1.8.  My last one was .21.  If it goes up, you can't help but
be concerned, but it's not by itself a sign of failure.  It's
only if you have a long term upward trend that you know your
treatment failed.

I was part of a clinical trial of MRI image guided HDR brachytherapy.
The doc in charge told me that a significant number of men in the
trial had PSA bounces, the highest one of which was something like
2.4.  But all eventually came down as of the last report.

   Alan

A bounce is not unusual in the first year or two. In lay terms and not
exactly being accurate about this, but the prostate after brachytherapy was
put on a slow kill cycle. In other words the RT damaged it beyond repair.
It's not going to die gracefully, and it will fight until it has lost. We
never saw a bounce. It could have happened in-between PSA tests or it could
have happened in the first six months. The prostate cells are going to
continue to divide and replace themselves but the genetic stuff is fouled up
so even if they do manage to do it the cells don't have the ability to
survive. The prostate might try to have one last hurray and put out a bunch
of cells (rise in PSA) but then those cells falter and die. Eventually you
wind up with nothing left.

A PCP did a DRE on my husband about a year ago and couldn't even find his
prostate.  The PCP commented that he didn't realize he'd had a RP. No he
didn't have a RP; he had brachy. At  this point my husband was white
knuckled while this doc was trying to find the prostate. I was there so I
told the doc he'd only feel a minor bump where the prostate should have
been. He was shocked that this little bump was what remained after brachy.
Yep, seeds and some scar tissue, maybe the half the size of a small dried
lima bean. We knew this because my husband's rad-onc kept giving us the
equivalents as the prostate died and receded.

Your 0.9 could have been a bounce and the next PSA could be 0.1, but there
is no way to know. Just remember it is a slow downward curve. It took my
husband about 3.5 years to hit the bottom. Each time we were so surprised to
see it fall one more time. So if the next one is 0.7 it's still going down,
or maybe that one is the bounce. You could ask for a three month PSA check.
I think the hardest part of brachytherapy is waiting for it to fall to the
bottom and worrying about the bounce that you might never see. I gather that
they want to see it fall to at least 0.2 and if it levels off there then
they will accept it but to watch it go further down is awesome. Three years
out from brachy he was 0.04, at sixteen months he was 0.18, and at 22 months
he was 0.15. At 28 months he fell to 0.10

The four year PSA will be the predictor for the 15 year PSA.

The benchmark PSA for 6 months is 2.0
The benchmark PSA for 2 years is under 0.2 and they figure they've got it.

3Putt you're well under the 6 month benchmark! Just stay ahead of the
benchmarks. Seems you're doing fine! I hope some of this helps.

I found this on a Google search:

Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):448-53

Prostate-specific antigen bounce after prostate seed implantation for
localized prostate cancer: descriptions and implications.

Stock RG, Stone NN, Cesaretti JA.

Department of Radiation Oncology, Mount Sinai School of Medicine, New
York, NY 10029, USA. rst...@mssm.edu

PURPOSE: To calculate the actuarial risk of developing a
prostate-specific antigen (PSA) bounce after prostate brachytherapy
alone, using three definitions of bounce mentioned in the literature,
and to explore the relationship between disease and treatment
variables and the risk of developing a bounce. The impact of PSA
bounce on PSA failure was also explored.

METHODS AND MATERIALS: A total of 373 patients with T1-T2 prostate
cancer underwent radioactive seed implant using 125I (n = 337) or
103Pd (n = 36) without hormonal therapy or external beam RT. All
patients had a minimum of 1 year (median 4, maximum 11) of follow-up
and at least three follow-up PSA values. PSA bounce was defined by a
rise of one or two PSA values with a subsequent fall. Three
definitions of bounce were used: definition 1, rise > or = 0.1 ng/mL;
definition 2, rise > or = 0.4 ng/mL; and definition 3, rise >35% of
previous value.

RESULTS: The actuarial likelihood of experiencing a PSA bounce at 5
years was 31% for definition 1, 17% for definition 2, and 20% for
definition 3. The median time to develop a bounce was 19.5 months for
definitions 1 and 2 and 20.5 months for definition 3. Gleason score,
initial PSA level, and clinical stage did not predict for bounce using
any definition. Using definition 1, younger patients (< or = 65 years)
had a bounce rate at 5 years of 38% vs. 24% for older patients (p =
0.009). 125I patients receiving an implant dose of < or = 160 Gy had a
bounce rate (definition 1) at 5 years of 24% vs. 38% for those
receiving a dose delivered to 90% of the gland on the 1 month
postimplant dose-volume histogram (D90) >160 Gy (p = 0.04). Using
definition 2, prostate volume significantly affected the incidence of
bounce. Patients with larger glands (>35 cm(3)) were more likely to
experience a bounce (23% at 5 years) than those with smaller glands (<
or = 35 cm(3)) who had a bounce rate of 11% at 5 years (p = 0.01). In
a multivariate analysis of factors predicting for PSA failure, PSA
bounce was not found to be significant.

CONCLUSION: PSA bounce is a common phenomenon after prostate
brachytherapy and occurs at a rate of 17-31%, depending on the
definition used. It is more common in younger patients, those
receiving higher implant doses, and those with larger glands. PSA
bounce does not predict for future PSA failure.

After confirming that I should be pleased with the progress my psa is
showing, my rad onc cautioned me that about 25 percent of seed implant
patients show a psa "bump" somewhere about the 1-year mark. She is
recommending that I still get my psa checked every three months for the
next year. I don't mind a cautious doctor.

Naaman

Surprisingly, there is apparently some evidence that men who
experience PSA bounce are _less_ likely to have a recurrence
of the cancer than men who don't.

Don't you love it when science predicts you're cured?

When I had my biggest uptick I thought, well, this is going to kill me,
but no one lives forever.  I reconciled myself to it and decided not
to let it ruin what was left of my life.  I lost less sleep than I did
in the
beginning when I first learned I had cancer.

Exactly.

   Alan