PSA bounce defined, guideline, in brachy

[JimmyToowong]

Urology. 2004 Jan;63(1):110-3.

PSA bounce predicts early success in patients with permanent iodine-125 prostate implant.

Patel C, Elshaikh MA, Angermeier K, Ulchaker J, Klein EA, Chehade N, Wilkinson DA, Reddy CA, Ciezki JP.

Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Abstract

OBJECTIVES: To determine the clinical and dosimetric factors that predict prostate-specific antigen (PSA) bounce after iodine-125 prostate brachytherapy and to determine the predictive value of PSA bounce relative to biochemical relapse-free survival (bRFS).

METHODS: A multivariate analysis of factors thought to predict for PSA bounce was performed in 295 consecutive patients with T1-T2 prostate cancer treated by prostate brachytherapy as the sole radiotherapeutic modality and a minimum follow-up of 2 years. The variables examined included age, initial PSA level, biopsy Gleason score, use of androgen deprivation, occurrence of PSA bounce, dose received by 90% of the prostate gland, and volume of gland receiving 100% of the prescribed dose. A PSA bounce was defined as a rise of at least 0.2 ng/mL greater than a previous PSA level with a subsequent decline equal to, or less than, the initial nadir. A second analysis investigating the same factors and adding PSA bounce as a predictor of bRFS was also performed.

RESULTS: The median follow-up was 38 months. A PSA bounce was noted in 82 (28%) of 295 patients. On multivariate analysis, only younger age (younger than 65 years) significantly predicted for a PSA bounce. Patients who experienced a PSA bounce were less likely to have biochemical failure (P = 0.037). Overall, the bRFS rate at 5 years in those experiencing a PSA bounce was 100% versus 92% in those with no bounce.

CONCLUSIONS: Immediate salvage therapy in patients with a rising PSA level after permanent prostate brachytherapy should not be initiated provided the PSA increase does not exceed the pretreatment PSA value. A PSA bounce may be associated with improved bRFS but was not associated with any of the pretreatment clinical and dosimetric factors examined.

PMID: 14751360 Forum: Primary hormone therapy Title: PSA bounce defined, guideline, in brachy

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