Prostate-specific antigen 'bounce' after permanent 125I-implant brachytherapy in Japanese men: a multi-institutional pooled analysis.
OBJECTIVE
To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level 'bounce' after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer.


METHODS
A multi-institutional pooled analysis was carried out in 388 consecutive patients with T1-T2N0M0 prostate cancer treated with (125)I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had >or=1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall.


RESULTS
The actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after (125)I-BT. Among the before and after (125)I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001).


CONCLUSIONS
PSA bounce is a common phenomenon after (125)I-BT and occurred at a rate of 19-51% in the Japanese men who underwent (125)I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after (125)I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.
Satoh
Takefumi
T
Department of Urology, Kitasato University School of Medicine, Kangawa, Japan. tsatoh@kitasato-u.ac.jp
Ishiyama
Hiromichi
H
Matsumoto
Kazumasa
K
Tsumura
Hideyasu
H
Kitano
Masashi
M
Hayakawa
Kazushige
K
Ebara
Shin
S
Nasu
Yasutomo
Y
Kumon
Hiromi
H
Kanazawa
Susumu
S
Miki
Kenta
K
Egawa
Shin
S
Aoki
Manabu
M
Toya
Kazuhito
K
Yorozu
Atsushi
A
Nagata
Hirohiko
H
Saito
Shiro
S
Baba
Shiro
S
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D012307:Risk Factors; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen