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

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.

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Conflict of interest

The authors have no direct or indirect commercial financial incentives or sources of funding associated with publishing the manuscript.

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Correspondence to Richard B. Wilder.

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Naghavi, A.O., Strom, T.J., Nethers, K. et al. Clinical implications of a prostate-specific antigen bounce after radiation therapy for prostate cancer. Int J Clin Oncol 20, 598–604 (2015). https://doi.org/10.1007/s10147-014-0745-8

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  • DOI: https://doi.org/10.1007/s10147-014-0745-8

Keywords

  • Prostatic neoplasms
  • Radiotherapy
  • Prostate-specific antigen