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

• Published in: Urology (Ridgewood, N.J.) Vol. 63; no. 1; pp. 110 - 113
• Main Authors: Patel, Chandrika, Elshaikh, Mohamed A., Angermeier, Kenneth, Ulchaker, James, Klein, Eric A., Chehade, Nabil, Wilkinson, D.Allan, Reddy, Chandana A., Ciezki, Jay P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2004; Elsevier Science
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - drug therapy; Adenocarcinoma - radiotherapy; Adult; Age Factors; Aged; Androgen Antagonists - therapeutic use; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Biomarkers, Tumor - blood; Brachytherapy; Combined Modality Therapy; Disease-Free Survival; Follow-Up Studies; Gonadotropin-Releasing Hormone - agonists; Humans; Iodine Radioisotopes - administration & dosage; Iodine Radioisotopes - therapeutic use; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Neoplasm Proteins - blood; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - radiotherapy; Radiotherapy Dosage; Risk Factors; Salvage Therapy; Treatment Outcome; Human; Nephrology; Implant; Implanted; Prediction; Early; Urogenital system; Prostate; Urology; Iodine
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2003.08.025

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).
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.
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.
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.