Temporary PSA rises and repeat prostate biopsies after brachytherapy.
OBJECTIVE
The long-standing confusion regarding the clinical relevance of postimplant biopsies is complicated by the common occurrence of temporary PSA rises between 1 and 2 years after brachytherapy. We report here 4 patients with temporary, self-limited PSA rises and postimplant biopsies, for whom radical prostatectomy was strongly advised but for whom surgery would probably have been the wrong choice.


METHODS
Transperineal I-125 or Pd-103 implants were performed as previously described. After implantation, patients were followed routinely, with repeat PSA and physical examination at approximately every 4 to 6 months. Timing of postimplant PSAs was at the discretion of the patient and his doctors. Postimplant biopsies were performed in all cases out of concern for a persistently elevated serum PSA. Sections of fixed and embedded tissue were stained with standard hematoxylin and eosin.


RESULTS
All 4 patients presented here were advised to have a salvage prostatectomy based primarily on their PSA changes. However, all of the patients have subsequently had a dramatic PSA fall, consistent with long-term cancer control, despite the fact that 3 of the 4 had histologic evidence of persistent cancer on repeat prostate biopsy.


CONCLUSIONS
It is crucial that clinicians be aware of the potential for the doubly confusing situation of temporary PSA rises and apparently positive rebiopsies and the pressure it puts on both patients and their physicians to go ahead with inappropriate salvage therapy.
Smathers
S
S
Department of Radiation Oncology, University of Washington, Seattle, Washington, USA.
Wallner
K
K
Sprouse
J
J
True
L
L
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D001918:Brachytherapy; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D018365:Neoplasm, Residual; D010165:Palladium / Q000627:therapeutic use; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D019564:Unnecessary Procedures
D014408:Biomarkers, Tumor; D007457:Iodine Radioisotopes; D009363:Neoplasm Proteins; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen