PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation

McGrath, Samuel; Antonucci, J. Vito; Fitch, Dwight L.; Ghilezan, Michel; Gustafson, Gary; Vicini, Frank A.; Martínez, Álvaro; Kestin, Larry L.

doi:10.1016/j.brachy.2009.07.005

Cited by 22 publications

(24 citation statements)

References 26 publications

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“…The dose rate can also be modulated in brachytherapy by using HDR. McGrath et al reported similar rates between LDR permanent seed brachytherapy (34%, n = 191) and exclusive HDR brachytherapy (36%, n = 93) [28]. Similarly, Makarewicz et al reported equivalent bounce rate while combining EBRT with HDR brachytherapy (31%, n = 31%) [19].…”

Section: Discussionmentioning

confidence: 96%

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

et al. 2012

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PurposeTo evaluate predictive factors for PSA bounce after 125I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses.Materials and methodsMen treated with exclusive permanent 125I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF) was defined using the criteria of the Phoenix conference: nadir +2 ng/ml.Results198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50). Bounce amplitude was 0.6 ng/ml (0.2-5.1), and duration was 13.6 months (4.0-44.9). In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007). In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p < 0.0001).ConclusionHigh PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.

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Section: Discussionmentioning

confidence: 96%

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

et al. 2012

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“…Reportedly, 17% to 62% of patients are diagnosed with PSA bounce using several definitions [1-10]. The median time to PSA bounce varied from 15 months to 26 months [1,2,4,6,7,9,10]. The median height of PSA bounce was 0.4 ng/mL to 0.8 ng/mL [1,2,4,6-9].…”

Section: Discussionmentioning

confidence: 99%

“…Several investigators have reported PSA (prostate-specific antigen) bounce, a transient PSA elevation that is frequently observed after low-dose-rate brachytherapy (LDR-brachytherapy) [1-10]. Although the factors that affect PSA fluctuation after LDR-brachytherapy are unclear, multiple factors including age, prostatitis due to radiation or urinary tract infection, acute urinary retention, laboratory error, instrumentation, ejaculation, radiation proctitis, and testosterone recovery after androgen deprivation therapy (ADT) are currently considered as etiologies of PSA bounce.…”

Section: Introductionmentioning

confidence: 99%

“…Several cut-off values of PSA, such as 0.1, 0.2, and 0.4 ng/mL, have been used to define PSA bounce. Seventeen to 62% of patients who underwent LDR-brachytherapy showed a PSA bounce during the first 3 years after LDR-brachytherapy [1-10]. The incidence of PSA bounce in Japanese patients is reportedly similar to that in American patients [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

et al. 2012

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BackgroundTo clarify the significant clinicopathological and postdosimetric parameters to predict PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer.MethodsWe studied 200 consecutive patients who received LDR-brachytherapy between July 2004 and November 2008. Of them, 137 patients did not receive neoadjuvant or adjuvant androgen deprivation therapy. One hundred and forty-two patients were treated with LDR-brachytherapy alone, and 58 were treated with LDR-brachytherapy in combination with external beam radiation therapy. The cut-off value of PSA bounce was 0.1 ng/mL. The incidence, time, height, and duration of PSA bounce were investigated. Clinicopathological and postdosimetric parameters were evaluated to elucidate independent factors to predict PSA bounce in hormone-naïve patients who underwent LDR-brachytherapy alone.ResultsFifty patients (25%) showed PSA bounce and 10 patients (5%) showed PSA failure. The median time, height, and duration of PSA bounce were 17 months, 0.29 ng/mL, and 7.0 months, respectively. In 103 hormone-naïve patients treated with LDR-brachytherapy alone, and univariate Cox proportional regression hazard model indicated that age and minimal percentage of the dose received by 30% and 90% of the urethra were independent predictors of PSA bounce. With a multivariate Cox proportional regression hazard model, minimal percentage of the dose received by 90% of the urethra was the most significant parameter of PSA bounce.ConclusionsMinimal percentage of the dose received by 90% of the urethra was the most significant predictor of PSA bounce in hormone-naïve patients treated with LDR-brachytherapy alone.

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“…Interpretation of a rising PSA within 3 years of therapy can be confused with a PSA bounce (7,8). The use of neoadjuvant therapy further complicates the interpretation of PSA bounce as recovery of testosterone also results in an increase (9). Both scenarios can lead to unnecessary treatment, especially because the pathologist can misread radiation effect on prostate cancer tissue as active disease (10,11).…”

Section: Diagnosis Of Local Recurrencementioning

confidence: 95%

Diagnosis and management of local recurrence after low-dose-rate brachytherapy

et al. 2015

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PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation

Cited by 22 publications

References 26 publications

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

Diagnosis and management of local recurrence after low-dose-rate brachytherapy

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