title: PSA bounce after permanent implant prostate brachytherapy may mimic a biochemical failure: a study of 295 patients with a minimum 3-year followup.
abstract: OBJECTIVE
  To assess the frequency and features of the PSA bounce phenomenon in a series of patients treated with permanent implant brachytherapy for prostate cancer, and to evaluate the percentage of cases in which this bounce could have mimicked a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology consensus criteria.
  
  
  METHODS
  From January 1999 to December 2001, 295 patients were treated with a permanent prostate implantation (real-time technique, with free (125)I seeds) by the Paris Institut Curie/Hospital Cochin/Hospital Necker Paris group. Duration of followup is 40.3 months (9-66 months). PSA level was reported at intervals not exceeding 6 months. Bounce was defined by temporary elevation in PSA level, followed by a spontaneous decrease.
  
  
  RESULTS
  In our series, 161 patients (55%) showed a transitory PSA increase (bounce) of at least 0.1 ng/mL; 145 patients (49%) a bounce of 0.2 ng/mL; 93 patients (32%) a bounce of 0.4 ng/mL; and 43 patients (15%) a bounce of at least 1 ng/mL. Mean PSA bounce was 0.8 ng/mL (0.1-4.1), and mean time to bounce was 19 months. Thirty-two patients (11% of total) presented three successive PSA increases, and therefore were to be considered as experiencing a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Among those 32 patients, 18 (56%) subsequently showed, without any treatment, a complete normalization of their PSA. In multivariate analysis, age <70 (p<0.0001) and D90>200Gy (p<0.003) were identified as independent factors for a PSA bounce of at least 0.4 ng/mL.
  
  
  CONCLUSIONS
  The observed rate of 32% of patients showing a PSA bounce of at least 0.4 ng/mL in our series is in good agreement with what has been previously reported in the literature. Among 32 patients fulfilling the classical ASTRO criteria for a biochemical relapse, 18 (56%) subsequently showed a spontaneous PSA decrease, questioning the ASTRO consensus for the biochemical followup of patients undergoing permanent implant prostate brachytherapy.
authors.affiliation: Department of Oncology Radiotherapy, Institut Curie, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Toledano
authors.forename: Laurent
authors.initials: L
authors.lastname: Chauveinc
authors.forename: Thierry
authors.initials: T
authors.lastname: Flam
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.forename: Suzette
authors.initials: S
authors.lastname: Solignac
authors.forename: Michel
authors.initials: M
authors.lastname: Timbert
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Rosenwald
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Cosset
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D017211:Treatment Failure
chemical_list: D017430:Prostate-Specific Antigen