PSA bounce after permanent implant prostate brachytherapy may mimic a biochemical failure: A study of 295 patients with a minimum 3-year followup

Prediction of PSA bounce after permanent prostate brachytherapy for localized prostate cancer

“…And in multivariate analysis, D90 greater than 180 Gy was identifi ed as an independent factor for a PSA bounce of at least 0.4 ng/ml. Stock et al 5 and Toledano et al 3 also showed a signifi cantly more frequent bounce rate for patients with a D90 greater than 160 Gy and a D90 greater than 200 Gy, respectively. Though it has been reported that no association was found between D90 and PSA bounce in the multi-institutional study of Japanese patients, 12 it is possible to explain the association of a PSA bounce with higher doses of radiation.…”

“…4,5,8,9,18,19 PSA bounce is a common phenomenon after brachytherapy. PSA bounce has previously been defi ned as an increase of more than 0.1 ng/ml, 3,5,8,9,12 followed by a subsequent decrease to less than that level; as an increase of more than 0.2 ng/ml, 2,3,6,7,11 followed by a decline or a minimal rise of 0.4 ng/ml 3,5,12 during a 3-6 month period, followed by a drop of any magnitude; or as a more than 35% elevation 5,12 in PSA compared with the most recent value, followed by a decline to a level at or less than the prebounce value. A rise of 0.1 ng/ml or 0.2 ng/ml may be too sensitive for clini- Table 2).…”

“…3,5,12 For each patient, PSA determinations were obtained at 3-month intervals after prostate brachytherapy implantation. The date of the fi rst increase in PSA was recorded for patients with multiple increases.…”

“…2 Approximately 15%-60% of hormone-naive patients show a temporary PSA elevation after brachytherapy. [2][3][4][5][6][7][8][9][10][11][12] It has been proposed that this PSA "bounce" is probably the result of some mechanism compromising membrane integrity; that is, radiation-induced prostatitis, in PSA-producing epithelium. In 1997, the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus conference recommended three consecutive increases in PSA levels after the nadir, with readings spaced 3-6 months apart, as the defi nition of biochemical failure.…”

PSA Bounce and Biochemical Failure After Brachytherapy for Prostate Cancer: A Study of 820 Patients With a Minimum of 3 Years of Follow-Up

“…Several definitions have previously used: an increase of $0.1 ng/mL (11), $0.2 ng/mL (12,13), 0.4 ng/mL (14), or 0.5 ng/mL (15) or simply an increase of any magnitude (16). It has also been defined as an elevation in PSA between $15% and 35% above the nadir value (14,17,18).…”