Good prognosis following a PSA bounce after high dose rate brachytherapy and external radiotherapy in prostate cancer

Åström, Lennart; Sandin, Fredrik; Holmberg, Lars

doi:10.1016/j.radonc.2018.08.011

Cited by 14 publications

(14 citation statements)

References 26 publications

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“…PSA failure was determined based on the Phoenix criteria (nadir + 2.0 ng/mL) [21]. A temporary PSA increase of ≥2.0 ng/mL was not classified as failure [22].…”

Section: Psa Assessmentmentioning

confidence: 99%

Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

Darwis

Oike

Kawamura

et al. 2020

Cancers

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This study aimed to first elucidate prostate-specific antigen (PSA) kinetics in prostate cancer patients treated with carbon ion radiotherapy (CIRT). From 2010 to 2015, 131 patients with prostate adenocarcinoma treated with CIRT (57.6 Gy relative biological effectiveness (RBE) in 16 fractions) alone were recruited. PSA was measured at 1, 2, 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, and 60 months post-CIRT. PSA bounce was defined as PSA increase over a cutoff followed by spontaneous decrease to or below the pre-bounce nadir. PSA failure was determined using the Phoenix criteria (nadir + 2.0 ng/mL). As a result, non-failure-associated temporary increase in PSA exhibited two distinct patterns, namely a classical bounce and a surge at one month. PSA bounce of ≥0.2 ng/mL was observed in 55.7% of the patients. Bounce amplitude was <2.0 ng/mL in 97.6% of cases. Bounce occurred significantly earlier than PSA failure. Younger age was a significant predictor of bounce occurrence. Bounce positivity was a significant predictor of favorable 5-year PSA failure-free survival. Meanwhile, a PSA surge of ≥0.2 ng/mL was observed in 67.9% of patients. Surge amplitude was significantly larger than bounce amplitude. Larger prostate volume was a significant predictor of PSA surge occurrence. PSA surge positivity did not significantly predict PSA failure. In summary, PSA bounce was distinguishable from PSA failure with regard to timing of occurrence and amplitude (earlier and lower for bounce, respectively). These data are useful for post-CIRT surveillance of prostate cancer patients.

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“…PSA failure was determined based on the Phoenix criteria (nadir + 2.0 ng/mL) [21]. A temporary PSA increase of ≥2.0 ng/mL was not classified as failure [22].…”

Section: Psa Assessmentmentioning

confidence: 99%

Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

Darwis

Oike

Kawamura

et al. 2020

Cancers

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“…The mechanism by which lower T stage tended to correlate with PSA bounces was unclear. Several previous studies have suggested that T stage has no correlation with PSA bounces [14,19,36]. Further investigation is warranted to reveal the correlation between T stage and PSA bounces.…”

Section: Plos Onementioning

confidence: 89%

“…PSA bounces can be disconcerting for patients and physicians [18], and they may lead to unnecessary salvage treatment for cases that meet the definition of PSA failure. Therefore, accurate clinical interpretation of PSA dynamics after radiotherapy for prostate cancer is necessary to avoid patient anxiety or a false-positive diagnosis of relapse, which can instigate unnecessary treatment [19].…”

Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen dynamics after neoadjuvant androgen-deprivation therapy and carbon ion radiotherapy for prostate cancer

et al. 2020

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Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria. Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 27, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–117) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age and lower T stage were significant predictors of PSA bounce. Younger age was a significant predictor of PSA failure. Conclusions In this study, we identified the significant predictors of the occurrence of PSA bounce and failure. Further follow-up is needed to reveal the clinical significance of PSA dynamics.

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“…Another study reported that PSA bounces after external beam radiotherapy were correlated with PSA failure [26]. By contrast, some reports stated that the PSA bounce was a good predictive factor for PSA failure [20].Hinnen et al found that PSA bounces after LDR-BT were predictive of better outcomes [35]. A long-term analysis suggested that the PSA bounce was a signi cant factor for better overall survival [36].…”

Section: Discussionmentioning

confidence: 99%

“…PSA bounces can be disconcerting for patients and physicians [19], and they may lead to unnecessary salvage treatment for cases that meet the de nition of PSA failure. Therefore, accurate clinical interpretation of PSA dynamics after radiotherapy for prostate cancer is necessary to avoid patient anxiety or a falsepositive diagnosis of relapse, which can instigate unnecessary treatment [20].…”

Section: Introductionmentioning

confidence: 99%

Prostate-Specific Antigen Dynamics After Carbon Ion Radiotherapy for Prostate Cancer

Takakusagi¹,

Oike²,

Kano³

et al. 2020

Preprint

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Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria.Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 26, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–116) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age was a significant predictor of PSA bounces and PSA failure. Conclusions The dynamics of PSA levels after CIRT was investigated in the present study. Further follow-up is needed to reveal the clinical significance of PSA dynamics.

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Good prognosis following a PSA bounce after high dose rate brachytherapy and external radiotherapy in prostate cancer

Cited by 14 publications

References 26 publications

Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

Prostate-specific antigen dynamics after neoadjuvant androgen-deprivation therapy and carbon ion radiotherapy for prostate cancer

Prostate-Specific Antigen Dynamics After Carbon Ion Radiotherapy for Prostate Cancer

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