International Journal of Clinical Oncology

, Volume 20, Issue 3, pp 598–604

Clinical implications of a prostate-specific antigen bounce after radiation therapy for prostate cancer

  • Arash O. Naghavi
  • Tobin J. Strom
  • Kevin Nethers
  • Alex A. Cruz
  • Nicholas B. Figura
  • Kushagra Shrinath
  • Binglin Yue
  • Jongphil Kim
  • Matthew C. Biagioli
  • Daniel C. Fernandez
  • Randy V. Heysek
  • Richard B. Wilder
Original Article

Abstract

Background

The objectives are to determine predictors of a prostate-specific antigen (PSA) bounce, whether a PSA bounce after radiotherapy for prostate cancer is associated with biochemical disease-free survival (bDFS), and the time course to a PSA bounce versus a biochemical failure post-irradiation.

Methods

Between July 2000 and December 2012, 691 prostate cancer patients without regional or distant metastases were treated with external beam radiation therapy and/or brachytherapy, and had at least 12 months of follow-up. A PSA bounce was defined as a temporary PSA increase of ≥0.4 ng/mL. bDFS was defined according to the nadir + 2 definition.

Results

The median follow-up was 42 months. The median time to first PSA bounce was 17 months (95 % confidence interval 15–18 months). In contrast, the median time to biochemical failure was 41 months (95 % confidence interval 28–53 months). Two hundred and twenty-six of 691 (33 %) patients had at least one PSA bounce with a median magnitude of 1.0 ng/mL (range 0.4–17.0). A Gleason score of 6 (p < 0.0001) predicted a PSA bounce on multivariate analysis. Patients with a PSA bounce experienced improved bDFS on multivariate analysis (p = 0.002).

Conclusions

Patients with a Gleason score of 6 were more likely to experience a PSA bounce which was associated with improved bDFS. A PSA bounce occurred sooner after radiotherapy than a biochemical failure. The authors recommend against performing prostate biopsies within 24–30 months of radiotherapy since an elevated PSA may simply represent a benign PSA bounce.

Keywords

Prostatic neoplasms Radiotherapy Prostate-specific antigen 

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Copyright information

© Japan Society of Clinical Oncology 2014

Authors and Affiliations

  • Arash O. Naghavi
    • 1
  • Tobin J. Strom
    • 1
  • Kevin Nethers
    • 1
  • Alex A. Cruz
    • 1
  • Nicholas B. Figura
    • 1
  • Kushagra Shrinath
    • 1
  • Binglin Yue
    • 2
  • Jongphil Kim
    • 2
  • Matthew C. Biagioli
    • 1
  • Daniel C. Fernandez
    • 1
  • Randy V. Heysek
    • 1
  • Richard B. Wilder
    • 1
  1. 1.Department of Radiation OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research InstituteTampaUSA

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