The Phenomenon of PSA Bounce After Radiation Therapy
Following radiotherapy for prostate cancer, the serum PSA level will fall to reach a nadir several years later. PSA bounce refers to a benign intermittent PSA rise prior to subsequent decrease. It has been observed in all forms of primary radiotherapy strategies, most recently in stereotactic radiation where it was noted in 29 % of patients. Comparison of published data is difficult due to variations in definitions, populations studied, and types of treatment. The majority of studies, however, do not reveal a relationship between PSA bounce and biochemical control. The only consistent pretreatment factor that appears to predict for PSA bounce is patient age at treatment. The updated ASTRO definition of biochemical failure following radiotherapy treatment (PSA nadir plus 2 ng/mL) aims to reduce the false-positive rate due to bounce but is not foolproof as bounces will still occur above this value. Pre-intervention counseling and judicious timing and frequency of PSA-testing posttreatment may help relieve the anxieties associated with PSA bounce.
- 2.Wallner KE, Blasko J, Dattoli MJ. Evaluating cancer status. In: Wallner KE, Blasko J, Dattoli MJ, editors. Prostate brachytherapy made complicated. Seattle: SmartMedicine Publishing; 1997. p. 11–4.Google Scholar
- 6.Horwitz EM, Levy LB, Thames HD, et al. Biochemical and clinical significance of the posttreatment prostate-specific antigen bounce for prostate cancer patients treated with external beam radiation therapy alone: a multi-institutional pooled analysis. Cancer. 2006;107(7):1496–502.PubMedCrossRefGoogle Scholar
- 8.Pickles T. Prostate-specific antigen (PSA) bounce and other fluctuations: which biochemical relapse definition is least prone to PSA false calls? An analysis of 2030 men treated for prostate cancer with external beam or brachytherapy with or without adjuvant androgen deprivation therapy. Int J Radiat Oncol Biol Phys. 2006;64(5):1355–9.PubMedCrossRefGoogle Scholar
- 20.Consensus statement: guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys. 1997;37(5):1035–41.Google Scholar
- 21.Roach III M, Hanks G, Thames Jr H, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65(4):965–74.PubMedCrossRefGoogle Scholar