If you have prostate cancer, your PSA score by itself is often not a very accurate indication of your condition before you begin your primary treatment, whether you have proton therapy, seeds or surgery. By contrast, PSA readings taken after your primary treatment are frequently highly indicative of whether your treatment is successful or not. That is why your doctor will want you to have your PSA taken every three months for a year or two after treatment.

What sort of PSA readings indicate that your treatment has been successful? Obviously, if you never had hormone therapy and your PSA reading is say, less than 1 ng/mL at your first three month checkup after treatment, that is very favorable. You're doing great if every one of your 3 month checkups produces a PSA of less than 1. But many, perhaps most of us do not have a PSA that drops right to the bottom after three months and stays there.

So what if your PSA does not drop very much at your first 3 month checkup? What if it actually goes up at your first check up? What if it bounces up after 3 months? Does that mean your proton therapy was a failure? Not necessarily.

Readings 3 months after treatment are rarely if ever conclusive. By itself, the first reading means very little. Instead, your doctor will look at your first three or four PSA readings to determine if there is a trend or a pattern of PSA readings. Now, let's take a look at a few patterns.

The first slide depicts the median patterns of a group of men following their treatments at the University of Florida proton center during the first two years. It comes from a study published online (in press) in 2010. PRO1 is the low risk group, PRO2 is the medium risk group and PRO3 is the high risk group. See how gradual the patterns are over the first two years after treatment ends (the line marked RT end). The exception is PRO3 the high risk group because they're put on hormone therapy at the end of their treatment, so their PSA drops much faster.

Just because your pattern is different from the first slide does not mean your treatment has failed. Quite the contrary. You can have a far different reading trend, but still have a favorable result. The second slide is taken from an Australian study published in 2009. It shows changes in readings over the course of one year. Note the big jump in the first 3 months from a PSA of 12 after treatment, up to 20 at the first reading. (So you think you've had it bad!) But then the next reading shows a drop to about 8, and then a gradual declining plateau. As long as the pattern drops, things are OK. So a big jump in the first couple of readings does not automatically mean your treatment failed, especially if a large drop follows. This slide shows a successful treatment so far.

The third slide shows changes in readings over nine years. Note that the first reading shows a drop from 12 only to 10 after the first post treatment reading. But then the PSA plunges to about 2 on the second reading. Between year 1 and year 2, the reading hits bottom, but then starts to go up, but never exceeding a PSA of about 2. By the middle of year 3 a plateau is reached, which stays consistent. Here again, we have a successful treatment.

Conclusions from Non-HT slides are summarized. Three take aways:

You don't need to lie awake the night before your first post treatment PSA reading worrying about what your PSA will be, or even before your second, third or fourth PSA reading. So stop worrying before each checkup!   

1. Normally, a pattern does not develop overnight. It can take as long as two or three years.
2. Plateau patterns are best.

Now for slides for those of you who are or have been on hormone therapy. Those show patients on short term hormone therapy (6 months or less.)   

The first HT slide shows a huge drop from a PSA of about 22 down to near zero for the first post-radiation treatment. This is a typical of what happens to your PSA when you start on Lupron. When you get off Lupron, your PSA bounces, but this one hardly bounced at all after ending Lupron. It's a flat and stable reading at a low PSA level. That is a pattern we like to see, particularly because of the near zero PSA reading on Lupron.    

This second Lupron slide shows a pattern like the first one, but there could be a couple of problem areas here. Notice that the bottom in the first year is a PSA of about 1. It's not near zero like the first slide. Second, you can see an upward PSA climb beginning in about year 5, which accelerates in year 7. If this patient is very old, much of the increase may be attributable to his age. If not, the increased PSA pattern may be a sign that there is some cancer that may be spreading. His proton doctor may well prescribe further treatment.

As with the non-HT slides, there are some take aways from these HT slides, too.

First, if you have HT before beginning protons or radiation, your chances of success are doubled if your PSA after HT is below a 0.5 reading, according to a 2010 abstract in a study done by our own Dr. Choi and Dr. Lee. (Remember that the patient on Lupron on the first slide bottomed out at about zero PSA, while the Lupron patient in the second slide bottomed out with a PSA of about 1; that relatively high bottom reading on Lupron is a clue of potential problems down the road for the man in the second slide.)

Two points to make on the HT slides. First, if you have HT before beginning protons or radiation, your chances of success are doubled if your PSA after HT is below a 0.5 reading, according to a study done by our own Dr. Choi and Dr. Lee which is summarized on the slide above. 

Second, once the HT is out of your system, then consider yourself like a non-HT patient and follow the results we've discussed above.

One final comment: Even if your pattern indicates possible problems, don't panic. Instead, discuss your situation with your proton doctor. The fact is that even if there are problems, the PSA gives a lead time of at least one year before symptoms start to show up. That is lots of time for your proton doctor to take action.

Good Luck!  

Dave Stevens 

Editor's Note:  If you want to discuss any of these charts or discuss a pattern that you have questions about, you may contact Dave directly but it would be most productive if you can use the Discussion Board located on our website at  ProtonPal/Legionnaire Discussion Group or http://protonpals.net/bbPress  That way others with similar concerns can learn from your questions.  

I wrote a good Users Guide to help you to get started with the Discussion Board, plus I will promise to serve as your technical support.  I'm not in Bangalore but in Houston. However I did hire a young graduate of a technical school from that country to integrate the discussion group with the ProtonPals website.   

Whether you're currently a patient at the PTC or a Proton Center Alumnus, you're invited read this and start a discussion on the "new" ProtonPals Discussion Board. .

■What happens to my PSA after Proton Therapy is over?

■What warning signs should I be on the lookout for?

■How can I tell if I am low risk, intermediate risk or high risk? And risk for what?

■Are there any side effects from Proton Therapy after I've "rung the gong?"

■Do the treatments continue to work after my 39 sessions are done?

■Why is a Gleason score so important? What does it look like under a microscope?

■What is the difference between a Gleason 7 (4+3) and a Gleason 7 (3+4)?

■What's next after if the protons don't kill all the cancer? What are the stages?

■What does it look like under a microscope when the protons kill cancer?

■If Proton Therapy kills the cancer, why do some men have hormone therapy?

■Doesn't the high dose radiation we get at the PTC make hormone therapy obsolete?

■Since I've been on Lupron, I'm having ED, mood swings, hot flashes and I just feel like sitting in my recliner all day. Does this happen to anyone else?

Support ProtonPals by letting us know how you're doing. That is so important to newly diagnosed men and their wives and partners.  As a former patient we'd all welcome your help in getting the word out about proton radiation and how you're doing. Please donate using the Donate Icon below or mail a check made out to ProtonPals, Ltd.(we're a tax deductible non-profit) at my home address.  Read more about about it on the website How to Help - Giving