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Joined: 10/10/2008
Posts: 11
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My pre-CK treatment PSA was 4.6 (Gleason 3+3). Since treatment my PSA has been:
3 mo 1.8
6 mo 1.9
9 mo 1.9
12 mo 1.3
15 mo 1.8
18 mo 2.2
Should I have concern about a lack of sustained drop and lack of lower PSA after these 18 months?
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Joined: 10/10/2008
Posts: 2346
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There is always cause for concern, but I think that you are probably experiencing the PSA "bounce" we often see at about this time. You are unfortunately going to just have to give it more time. PSA responses in the first couple of years are pretty variable.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/11/2008
Posts: 928
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Continue to monitor the PSA values for 6-12 more months before drawing any conclusions.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 355
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Agree this appears most consistent with a benign PSA bounce - We see those in about a third of the patients and 12 - 24 months post-tx is the classic time when the infamous "bounce" is observed . . .
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 35
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For what it is worth here are my PSA reading: Pre-CK 4.3 4/08 2.2 7/08 1.5 10/08 1.82 1/09 1.58 4/09 2.0 6/09 1.4 10/09 1.24 According to my urologist the cancer cells are destroyed but the prostate becomes extremely agitated (whatever that means) and affects the PSA levels for some time. We are now looking forward to another follow up in January and again in another three months. At the same time I thought it was the cancer that produced the antigens but I guess beating up other cells with radiation also causes the antigens to be produced.
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Joined: 10/11/2008
Posts: 928
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Your general PSA trend has been downward.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 11
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Thanks to all of you for the assurance (again) and being patient about PSA levels during the 24 months or so. No anxiety here.....
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Joined: 10/10/2008
Posts: 8
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Happy news! My husband just got his 18 month PSA result. I have listed his trend for the statisticians out there.
Pre-CK 8.5 -> 8.0 (Two tests, lots of variation)
7.2 (3) months post CK
5.7 (6) months
3.43 (9) months
3.43 (1) year
2.37 (15) months
1.87 (18 months
He's still doing great, everything works, and he feels good!
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Joined: 10/10/2008
Posts: 2346
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Good to hear it!
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/11/2008
Posts: 928
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Like the stock market, heading downward.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 11
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Here's the good news. Today I got my 21 month PSA. After being 2.2 three months earlier, it is 0.9 today. Seems my "classic bounce" is over. This is continued encouragment and confirmation that CK was a great choice for me. I continue with no side effects and couldn't be more pleased with my outcome.
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Joined: 10/10/2008
Posts: 355
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Sweet!!
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/11/2008
Posts: 928
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Like honey.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 7
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I will throw in my PSA results. Pre treatment = 1.6; three years 3 mos. later = 0.13. I never experienced a "bump." I have done quite well except having scar tissue build up in the urethra which is not a minor thing. My suprapubic tube was "installed" December 1, 2009 and to date has caused no problems. I am probably 90% normal with my lifestyle. I walk five miles a day and swim 30 minutes after walking. I have had one infection which is obviously a risk with self-dilation or having a suprapubic tube. My infection was prior to my resuming swimming four weeks after the suprapubic procedure. So, it was not the pool water at my fitness club that caused the infection. Presently, I am weighing the risks of reconstructive surgery or keeping the suprapubic tube as long as it is serving me well. I can live with this tube better than the self-dilation.
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Joined: 10/10/2008
Posts: 35
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I am just now two years post CK treatment and my PSA did bounce around but with an overall downward movement. My most recent PSA was .050 and was 1.23 just three months ago. I think the whole experience has been successful. I knew I made the right choice when I decided to have CK treatments. I had issues with other treatments and my investigation and research into CK and how it works convinced me that it addressed the issues I had with other treatments. I remain frustrated that Cyberknife treatments are still not widely found in the literature on PC treatments but I do think progress has been made since I learned about it a little over two years ago. All you have to do is look on this site to find out what facilities have cyberknife, the number has greatly increased over two years ago. Lets make it a personal mission to spread the word.
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Joined: 12/4/2009
Posts: 32
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Had my last of 5 CK treatments yesterday. Are there "standard" things to expect at the one month followup? When does scar tissue build up in the urethra?
Bob
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Joined: 10/10/2008
Posts: 2346
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Most people do not develop any urethral scarring Don had an unusual problem which we have been unable to explain. It is the only time we have seen it. But you should report all symptoms to your treatment team immediately.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 12/4/2009
Posts: 32
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I forgot to take the steroid right after treatrment. I had a lot of "stinging" and frequency, but that subsided later in the evening. I did call the treatment team.
Are there standard things to expect at the 1 month followup?
Bob
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Joined: 3/22/2009
Posts: 36
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Bob-- All my side effects had disapated by 2 weeks after my last treatment. They were "urgency" that was pretty much cleared up with Flomax and fatigue.
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Joined: 10/10/2008
Posts: 2346
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There is nothing special to expect at one month.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 12/4/2009
Posts: 32
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What is being looked for at one month?
How long does fatigue last typically?
Bob
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Joined: 10/10/2008
Posts: 2346
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I don't know why you are particularly concerned about one month. There is nothing special expected then. It is just a visit to make sure you have recovered from any symptoms. It will not tell you anything about your cancer.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 3/22/2009
Posts: 36
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Bob--After each of my treatments, I just went back to work. When I got home, I just took a nap for an hour. This pretty much stopped 2 weeks after my last treatment
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Joined: 12/4/2009
Posts: 32
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radsrus - I am not particularly concerned. Just curious about what they are looking for with the blood draw.
copperten - slept for four hours after the 1st ck treatment. Bounced back to work the next day. No special fatigue since. Back to work the following day. That sure beats a six week recovery.
Bob
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Joined: 10/10/2008
Posts: 35
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I had the five radiation sessions in a row. I was extremely fatigued after each session and fell asleep in the afternoon and all trough the night. I was somewhat fatigued for two or three days after that and then it was gone. Some burning with urination, definitely knew I had radiation treatments, but in a week it was gone and that was basically it. While I felt amazingly good for such intense treatment I realized by looking back over the past two years that it took that much time to fully feel like myself again but I only realized that after looking back. When I think that I could have eight weeks of daily radiation treatments with bracytherapy or several weeks of major recovery time for radical, I was thankful daily for finding CK as a treatment. One month follow up was only for a PSA screening and a DRE to check for a drop in PSA and to check on the condition of the prostate. After all it was wacked with radiation but no problems. I had similar examinations every three months thereafter to check on the same with occassional questions from my urologist for bowel issues or ED issues. No bowel issues and some moderate ED issues easily remidied with Cialis at first but now no issues at all. I am now on a six month examinations cycle.
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Joined: 10/10/2008
Posts: 7
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Since radiation I have increased urgency and the closer to the bathroom I get the more urgent things get. Other radiation patients I know have said they have the same sensation. Also, I can go longer the less I think about it. Do you Docs have a fancy name for this mental thing?
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Joined: 10/10/2008
Posts: 2346
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How about peebrain?
Or urinal yearning?
I don't know of any scientific term.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/10/2008
Posts: 7
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That will work.
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Joined: 10/10/2008
Posts: 355
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Call of the (wild) tiled . . .
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 25
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Oh oh. Looks like I am a bit unique with my PSA bounce. I was posting here starting back in August 2008 when I had the CK treatments. My PSA had reached as high as 21 before CK. I have had no bad side effects after doing CK. After CK, my PSA gradually dropped to a low of about 3.5 at about the 15 month anniversary of CK, about November 2009. Then I had the PSA test done yesterday, and at the time my doc said after a digital rectal exam, the prostate was "flat". Presumably a good sign. I was expecting to have him tell me today, my PSA had continued to drop. Instead, he told me this morning that it was 11.6! He mentioned a bounce was common, but nevertheless he has ordered a bone density scan and cat scan for me in the next few days. I'll report back next week with the results...Ron Pavluvcik, Shelton, CT
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Joined: 10/11/2008
Posts: 928
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That is rather high for a "bounce". I agree with the bone scan and CT at this point.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 355
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Our "bounce record" to my recollection is 7.7ng/ml - This could be one, and I hope it is one, but I share Dr. Spunberg's concern - One other thing that isn't prostate cancer that can drive PSA into the double digits is infection-prostatitis, so you might also ask you doc about that possibility. Good luck.
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 379
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Hi Ron,
Hope the bounce is an anomaly and you scans are negative.
Best Wishes
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Joined: 10/10/2008
Posts: 25
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Ron here again with the big bounce. As I wait to get the cat scan and bone density scan tests to be done on 3/26 and 3/29 respectively after my PSA came back at 11.6 yesterday, I had another PSA test done this morning at a different hospital, and it came back even higher at 12.6. So I have some kind of problem percolating, and thanks for the tip that it might be something other than cancer such as prostatitis infection. I will post results of the upcoming two scans as soon as I can, for the benefit of others here...by the way: my bone density scan test could not be done sooner because 2 different test sites here are out of the injected isotope, until next week! Anybody know what's going on to cause this?
Ron Pavluvcik, Shelton, CT
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Joined: 10/11/2008
Posts: 928
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Are you having any symptoms that might suggest prostatitis? Such as burning on urination, excessive frequency, or pain?
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 25
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The only change in related symptoms I've experienced in recent months since my last PSA test, is more frequent nightly urination. I actually casually mentioned this to my CK doc on Monday when he asked, even before we got the new PSA test result back at 11.6, and the first thing he asked was whether I was drinking more fluids before bedtime. I answered yes, I had started drinking 1-2 cups of coffee every other night or so say at about 7-8 PM to help me stay awake longer, (since I have been awaking earlier at 5 AM each day for my dog), before sleep at 11-12 PM, and the doc said this could explain the more frequent urination of me going from 2 times per night to 3 times, since coffee/caffeine is a diuretic. I accepted that explanation, until the PSA came back at 11.6. So maybe there is a case of prostatitis / infection causing the big PSA bounce. Ron Pavluvcik, Shelton, CT
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Joined: 10/11/2008
Posts: 928
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Let's hope so...
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 2346
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Most centers have traditionally gotten their radioisotopes from Canada, and they took down their reactor for maintenance, and I think one went down in Europe as well. Has made things difficult for isotopes. There is talk of building a US facility to ensure availability.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/10/2008
Posts: 25
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Got my test results back today. (I'm the guy with the big PSA bounce to 11.6 that just occurred, some 15 months after my CK treatment. See my original post on this issue from last week back up this thread.) Well, I'm OK for now. The cat scan, looking for cancer in the lymph nodes, and the bone density scan, looking for cancer in the bones, both came back negative today. My doc says he still has some concern, that maybe there is some cancerous material, microscopic in size, still inside of me some place that caused the big PSA bounce. Nothing else he can do for now. He wants me to come in for another PSA test in 3 months instead of the usual 6 months. I feel relieved of course, but also disappointed to learn that I need to keep monitoring this thing more closely, probably for a long time, and that I might need some kind of treatment eventually again, if the cancer returns. I still am a big supporter of the CK treatment option, and have no regrets on choosing it, considering my lack of other side effects. I would appreciate hearing from the doc's on my expereince, and their own opinions...thanks in advance..Ron Pavluvcik, Shelton, CT
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Joined: 10/10/2008
Posts: 379
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Hi Ron,
Glad your scans were negative.
Did you have any test, blood, etc. to check for an infection that could boost your PSA?
Best Wishes,
Fred
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Joined: 10/10/2008
Posts: 355
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One other thing that we do sometimes do in a man with a "PSA bounce versus relapse" question is to add a course of antibiotics for prostatitis, empirically (meaning treat it as prostatitis even if we can't prove there is prostatitis), before the next repeat PSA check. This is not an official recommendation, but you might want to ask your doc about it.
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 2346
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Just don't let them be in a hurry to make any decisions. PSA can go up three times and still come back down (at least in our experience).
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/11/2008
Posts: 928
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Ours too, but that is atypical.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 355
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Speak of the devil, we may just be seeing a new "PSA-Bounce record setter" in our practice - We have a case where the PSA ran all the way up to 9.7 ng/ml 18 months after treatment, and is now drifting back downward 24 months post-treatment, without any specific treatment. Remember, PSA is just a quantitative chemical marker with imperfect specificity, not a disease in and of itself... Be very sure you have relapse before accepting any other secondary treatment.
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 25
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I'm the guy with the big PSA bounce. I mentioned to my CK doc that I had learned from the Cyberknife website, this forum, that I might have a case of infectious prostatitis, and that people here recommended trying some antibiotics before taking another PSA test. He agreed, and prescribed Cipro for me, which I have started taking, for the next 10 days. I will get another PSA test sometime in May, and will report the results back here. Thanks to all who contributed their expertise and support. Ron Pavluvcik, Shelton, CT -(Still a fan of Cyberknife).
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Joined: 10/10/2008
Posts: 2346
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Just in case you have a case of smoldering prostatitis, you might want to get the PSA shortly after finishing the antibiotic coiurse
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/10/2008
Posts: 25
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"Smoldering prostatitis" huh - not a pretty picture! But OK - will check in here again after I finish the Cipro antibiotic in 9 days, and then get another PSA test - see you all around May 15th...Ron Pavluvcik, Shelton, CT
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Joined: 10/10/2008
Posts: 25
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Whoops - wrong month - I will post again after the Cipro is gone and another PSA test, around APRIL 15th....Ron P.
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Joined: 10/10/2008
Posts: 25
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Had another PSA test today after finishing on Saturday, 10 days of treatment with the antibiotic Cipro - PSA came in today at 14.4. Someone here told me to have the PSA test right away after finishing the Cipro, so I did today, but someone else told me off-line that I should wait a week or more after finishing the Cipro, to give it more time to do its thing - so I am planning another PSA test in 7-8 days from now, and will report back. Meanwhile, any other thoughts or theories on this? I hope the CK treatment back in August 2008 killed all the cancer, but if not, what would be the best option going forward? Thanks... Ron Pavluvcik, Shelton, CT
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Joined: 10/10/2008
Posts: 355
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Let us know what the next one shows. Still processing . . .
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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