PSA bounce is common following seed implantation for prostate cancer. It produces anxiety in men previously treated for prostate cancer and confounds the diagnosis of recurrence.

Background. Because results of retropubic I‐125 implantation for prostate cancer have been poor, external beam radiation was added postimplant. Serum prostate specific antigen (PSA) was used to assess this approach of combined irradiation. Methods. Two hundred and thirty‐nine patients with clinical Stage T1 or T2 but surgically node‐negative prostate cancer were treated. Results were monitored by serial serum PSA evaluation. Positive clinical findings or a rising PSA level defined recurrent disease. Results. With a median follow‐up of 45 months (range, 24‐120 months), the Kaplan‐Meier projected disease free survival rate was 74% at 5 years and 66% at 10 years. Overall at a 60‐month minimum follow‐up, 77% of patients had a PSA of 0.5 ng/ml or less. This nadir level is highly predictive of a long term disease free survival, significantly better than pretreatment PSA, grade, or clinical Stage T1 or T2. Conclusions. The PSA‐monitored disease free survival rate after combination irradiation appears comparable with that after radical prostatectomy and perhaps superior to that after external‐beam radiation. This effect was achieved even though lower‐than‐usual doses of radiation from both sources were administered. The combination of an I‐125 implant followed by external‐beam radiation produces high doses within the prostate and, to a lesser extent, in the periprostatic tissue. Additive and synergistic effects from simultaneous irradiation may be responsible for these results.

No abstract

No abstract

PSA nadir is the fundamental measurement that determines possible cure after radiotherapy. Except for perhaps rare occasions, men must at least achieve a nadir of 0.5 ng/ml. or less to be cured of prostate cancer by irradiation. However, the prognostic value of this nadir level depends on most men achieving a nadir of 0.2 ng/ml or less. Disease freedom for radiotherapy, defined as achievement and maintenance of PSA nadir 0.5 ng/ml or less, is reasonable.