title: Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence.
abstract: OBJECTIVE
  To evaluate predictive factors for PSA bounce after 125I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses.
  
  
  METHODS
  Men treated with exclusive permanent 125I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF) was defined using the criteria of the Phoenix conference: nadir +2 ng/ml.
  
  
  RESULTS
  198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50). Bounce amplitude was 0.6 ng/ml (0.2-5.1), and duration was 13.6 months (4.0-44.9). In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007). In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p < 0.0001).
  
  
  CONCLUSIONS
  High PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.
authors.affiliation: Radiation Therapy Department, Centre Léon Bérard, 28, rue Laënnec, 69373 Lyon Cedex, France. renaud.mazeron@igr.fr
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.forename: Agathe
authors.initials: A
authors.lastname: Bajard
authors.forename: Xavier
authors.initials: X
authors.lastname: Montbarbon
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gassa
authors.forename: Claude
authors.initials: C
authors.lastname: Malet
authors.forename: François
authors.initials: F
authors.lastname: Rocher
authors.forename: Sébastien
authors.initials: S
authors.lastname: Clippe
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bringeon
authors.forename: Olivier
authors.initials: O
authors.lastname: Desmettre
authors.forename: Pascal
authors.initials: P
authors.lastname: Pommier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000532:radiotherapy*; D012307:Risk Factors
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen