title: Prostate-specific antigen bounce after intensity-modulated radiotherapy for prostate cancer.
abstract: OBJECTIVE
  To report prostate-specific antigen (PSA) bounce in patients treated with intensity-modulated radiotherapy (IMRT) alone. Previous studies have reported PSA bounce in prostate cancer patients treated with conventional radiotherapy, 3D conformal radiotherapy, and permanent seed brachytherapy.
  
  
  METHODS
  From January 1997 to July 2002, 102 patients with clinically localized prostate cancer were treated with IMRT alone. No patients received androgen ablation. PSA bounce was defined as a PSA increase of at least 0.4 ng/mL, followed by any PSA decrease. Biochemical failure was defined by both the American Society for Therapeutic Radiology and Oncology 1996 and 2006 consensus definitions.
  
  
  RESULTS
  The median follow-up was 76 months. The median length of time until the first PSA bounce was 13.6 months. Thirty-three patients (32.4%) had at least 1 PSA bounce, with 25 (24.5%) having 1 bounce; 6 (5.9%), 2 bounces; and 2 (2.0%), 4 bounces. PSA bounce was not significantly associated with biochemical no evidence of disease survival, clinical stage, pretreatment PSA, Gleason combined score, prostate planning target volume, PSA nadir, or mean dose to the prostate. The rate of PSA bounce in patients aged ≤ 70 and > 70 years was 44.4% and 22.8%, respectively (P = .032).
  
  
  CONCLUSIONS
  Our patient series is the first report on PSA bounce in patients treated with IMRT. Our study confirms that the majority of patients with a bouncing PSA remain biochemically and clinically free of disease with extended follow-up.
authors.affiliation: Department of Radiology/Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Sheinbein
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.forename: Wei Y
authors.initials: WY
authors.lastname: Mai
authors.forename: Walter
authors.initials: W
authors.lastname: Grant
authors.forename: Arnold
authors.initials: A
authors.lastname: Paulino
authors.forename: E Brian
authors.initials: EB
authors.lastname: Butler
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000532:radiotherapy*; D000368:Aged; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen