Prostate specific antigen bounce after simultaneous irradiation for prostate cancer: the relationship to patient age.
OBJECTIVE
We report on the relationship of patient age to prostate specific antigen (PSA) bounce after brachytherapy for prostate cancer.


METHODS
From 1992 to 1997, 1,011 consecutive men with stage T1-T2NxM0 prostate cancer were treated with simultaneous irradiation, transperineal prostate I-125 implant followed by external beam irradiation. No patients received neoadjuvant hormones. There were 251, 491 and 269 men 60 years old or younger, 61 to 70 and 71 or older, respectively, at implant. PSA bounce is defined by a postirradiation PSA increase of 0.1 ng/ml or more above the level before bounce followed by a decrease to or below that level. Disease freedom is defined by a PSA cut point of 0.2 ng/ml. Median followup is 6 years (range 3 months to 10 years).


RESULTS
The frequency of PSA bounce according to age 60 or younger, 61 to 70 and 71 or older is 57%, 41% and 26%, respectively, a significant difference (p <0.000), average time to bounce onset is 19, 20 and 25 months for these 3 age groups, respectively, a significant difference (p = 0.002), and average bounce duration is 11, 8 and 8 months, respectively, a significant difference (p <0.000). On multivariate analysis of age, pretreatment PSA, Gleason score, stage, implant dose, prostate volume, diabetes and race, only age is significantly associated with PSA bounce (p <0.0001). After adjusting for the inherent bias caused by PSA bounce, there is no significant difference in disease-free survival between men with and without bounce.


CONCLUSIONS
Young men with prostate cancer treated with brachytherapy have a significantly higher frequency, earlier onset and longer duration of PSA bounce than older men.
Critz
Frank A
FA
Radiotherapy Clinics of Georgia, 2349 Lawrenceville Highway, Decatur, GA 30033, USA.
Williams
W Hamilton
WH
Levinson
A Keith
AK
Benton
James B
JB
Schnell
Frederick J
FJ
Holladay
Clinton T
CT
Shrake
Philip D
PD
D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen