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

PSA-Bounce nach 125I-Brachytherapie bei Prostatakarzinom als günstiger prognostischer Faktor

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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.

Zusammenfassung

Hintergrund

Die permanente Low-dose-rate-Brachytherapie (BT) mit 125I ist ein etabliertes kuratives Verfahren bei lokalisiertem Prostatakarzinom. Posttherapeutisch können die PSA-Konzentrationen einen vorübergehenden Anstieg zeigen (Bounce-Phänomen). Untersucht werden sollte ein möglicher Zusammenhang mit der biochemischen Kontrolle.

Methoden

Patienten, die eine BT in der Schweiz bekommen hatten, wurden in einer prospektiven Datenbank erfasst. Nur Patienten mit mindestens 2 Jahren Nachsorge wurden in die Studie eingeschlossen. Klinische Verlaufskontrollen mit PSA-Messungen erfolgten nach 1, 5, 3, 6 und 12 Monaten sowie anschließend jährlich. Bei einer PSA-Erhöhung wurden weitere Termine vereinbart. Der PSA-Bounce wurde definiert als ein Anstieg des PSA-Wertes um mindestens 0,2 ng/ml über den initialen PSA-Nadir mit anschließendem Absinken auf diesen Wert oder tiefer ohne Therapie. Biochemisches Versagen wurde definiert als Nadir+2ng/ml.

Ergebnis

Eingeschlossen wurden 713 Patienten, die zwischen 03/2001 und 11/2010 eine BT und mindestens 2 Jahre (mediane Nachsorgedauer 41 Monate) Nachsorge erhalten hatten. Ein biochemisches Versagen zeigte sich bei 28 Patienten (3,9 %). Bei 173 (24,3 %) Patienten konnte ein Bounce beobachtet werden, nur 3 (1,7 %) entwickelten anschließend ein biochemisches Versagen. Dagegen entwickelten 25 (4,6 %) Patienten ohne Bounce ein biochemisches Rezidiv (p < 0,05). Die mediane Zeit bis zum Bounce betrug 12 Monate, die mediane Zeit bis zum biochemischen Versagen 30. Der mediane PSA-Anstieg beim Bounce war 0,78 ng/ml. Achtundzwanzig Patienten (16,5%) mit einem Bounce hatten einen temporären PSA-Anstieg von + 2 ng/ml über den Nadir.

Fazit

In den meisten Fällen war ein früher PSA-Anstieg nach BT mit einem Bounce verbunden; dieser ist mit einem niedrigeren Risiko für ein biochemisches Rezidiv assoziiert.

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Acknowledgments

The authors thank Alistair Reeves for editing the manuscript.

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Authors and Affiliations

  1. Department of Urology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Daniel S. Engeler,  Christoph Schwab &  Hans-Peter Schmid

  2. Department of Radiation Oncology, Lindenhofspital Berne, Berne, Switzerland

    Armin F. Thöni

  3. Department of Urology, Hirslanden Klinik Aarau, Aarau, Switzerland

    Werner Hochreiter

  4. Department of Urology, Klinik Uroviva Bülach, Bülach, Switzerland

    Ladislav Prikler

  5. Department of Urology, Cantonal Hospital Zug, Zug, Switzerland

    Stefan Suter

  6. Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland

    Patrick Stucki

  7. Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Johann Schiefer,  Ludwig Plasswilm &  Paul Martin Putora MD PhD MA

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  1. Daniel S. Engeler
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Correspondence to Daniel S. Engeler.

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Conflict of interest

D.S. Engeler, C. Schwab, A.F. Thöni, W. Hochreiter, L. Prikler, S. Suter, P. Stucki, J. Schiefer, L. Plasswilm, H-P. Schmid, and P.M. Putora state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Engeler, D., Schwab, C., Thöni, A. et al. PSA bounce after 125I-brachytherapy for prostate cancer as a favorable prognosticator. Strahlenther Onkol 191, 787–791 (2015). https://doi.org/10.1007/s00066-015-0860-0

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  • DOI: https://doi.org/10.1007/s00066-015-0860-0

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