Publication

PSA bounce after (125)I-brachytherapy for prostate cancer as a favorable prognosticator

Journal Paper/Review - Jun 23, 2015

Units
PubMed
Doi

Citation
Engeler D, Schmid H, Plasswilm L, Schiefer J, Stucki P, Suter S, Prikler L, Hochreiter W, Thöni A, Schwab C, Putora P. PSA bounce after (125)I-brachytherapy for prostate cancer as a favorable prognosticator. Strahlenther Onkol 2015; 191:787-791.
Type
Journal Paper/Review (English)
Journal
Strahlenther Onkol 2015; 191
Publication Date
Jun 23, 2015
Issn Electronic
1439-099X
Pages
787-791
Brief description/objective

BACKGROUND
Permanent low-dose-rate brachytherapy (BT) with iodine 125 is an established curative treatment for localized prostate cancer. After treatment, prostate-specific antigen (PSA) kinetics may show a transient rise (PSA bounce). Our aim was to investigate the association of PSA bounce with biochemical control.

PATIENTS AND METHODS
Patients treated with BT in Switzerland were registered in a prospective database. Only patients with a follow-up of at least 2 years were included in our analysis. Clinical follow-up and PSA measurements were assessed after 1.5, 3, 6, and 12 months, and annually thereafter. If PSA increased, additional follow-up visits were scheduled. Cases of PSA bounce were defined as a rise of at least 0.2 ng/ml above the initial PSA nadir with a subsequent decline to or below the initial nadir without treatment. Biochemical failure was defined as a rise to nadir + 2 ng/ml.

RESULTS
Between March 2001 and November 2010, 713 patients with prostate cancer undergoing BT with at least 2 years of follow-up were registered. Median follow-up time was 41 months. Biochemical failure occurred in 28 patients (3.9 %). PSA bounce occurred in 173 (24.3 %) patients; only three (1.7 %) patients with PSA bounce developed biochemical failure, in contrast to 25 (4.6 %) patients without previous bounce (p < 0.05). The median time to bounce was 12 months, the median time to biochemical failure was 30 months. The median bounce increase was 0.78 ng/ml. Twenty-eight patients with bounce (16.5 %) had a transient PSA rise of + 2 ng/ml above the nadir.

CONCLUSION
In most cases, an early increase in PSA after BT indicates PSA bounce and is associated with a lower risk of biochemical failure.