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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 10/2015

01-10-2015 | Original Article

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

Authors: Dr. med. Daniel S. Engeler, Dr. med. Christoph Schwab, Dr. med. Armin F. Thöni, Dr. med. Werner Hochreiter, Dr. med. Ladislav Prikler, Dr. med. Stefan Suter, Dr. med. Patrick Stucki, Dr. phil. Johann Schiefer, PD Dr. med. Ludwig Plasswilm, Prof. Dr. med. Hans-Peter Schmid, Dr. Paul Martin Putora, MD PhD MA

Published in: Strahlentherapie und Onkologie | Issue 10/2015

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Abstract

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.
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Metadata
Title
PSA bounce after 125I-brachytherapy for prostate cancer as a favorable prognosticator
Authors
Dr. med. Daniel S. Engeler
Dr. med. Christoph Schwab
Dr. med. Armin F. Thöni
Dr. med. Werner Hochreiter
Dr. med. Ladislav Prikler
Dr. med. Stefan Suter
Dr. med. Patrick Stucki
Dr. phil. Johann Schiefer
PD Dr. med. Ludwig Plasswilm
Prof. Dr. med. Hans-Peter Schmid
Dr. Paul Martin Putora, MD PhD MA
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 10/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0860-0

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