Can a PSA bounce be seen shortly after SBRT to prostate cancer oligometastases while on androgen deprivation therapy?
This patient's PSA rose from 0.2 to 2.0 at 3 months post-SBRT without PSMA avid lesions. How would you manage this: intensify treatment (such as with ARSI), follow with serial PSAs, or consider changing management in a different way?
Answer from: Radiation Oncologist at Academic Institution
I would not consider it a "bounce" if it happens shortly after treatment because the timing of a post-treatment bounce is later. If the PSA is higher than pre-treatment baseline soon after metastasis-directed SBRT, then you are likely observing one of two scenarios. First, the pre-treatment baseline...
Answer from: Radiation Oncologist at Community Practice
I have seen a PSA bounce if the PSA is done sooner than 3 months, even while castrate. This is why I do not order a PSA until at least 3 months post any radiation, including to the primary or to metastatic sites.
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Radiation Oncologist at AdventHealth Cancer Institute My experience is the same - up to 6 weeks, for SBR...
Answer from: Radiation Oncologist at Community Practice
Some additional commentary and a clarification on my comment to Dr. @Chaudhary’s answer below:
The nuance here is about the target structure and purpose - for intact primary prostate treatment, I agree completely and have also noted these bounces. Literature traditionally describes bounces in...
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Radiation Oncologist at Coastal Radiation Oncology It appears that the question centers around a pati...
Answer from: Radiation Oncologist at Academic Institution
PSA bounces are more common in SBRT cases. They occur much later than most of us were taught; median of 14 months, i.e., beyond the three-month follow-up time points noted. This is, of course, extrapolated from localized treatment vs oligomets such as an excellent meta-analysis from Germany (Dejonck...
Answer from: Radiation Oncologist at Academic Institution
Echoing the excellent points here, I think for a patient with known metastatic disease on ADT with rising PSA 3 months after SBRT is concerning.
I have seen bounces for mets directed RT in men who are using SBRT to delay or defer ADT at 3 months, but if testosterone is truly at castrate levels, the...