Prostate-specific antigen bounce after curative brachytherapy for early-stage prostate cancer: A study of 274 African-Caribbean patients.
BACKGROUND
Prostate cancer incidence in the African-Caribbean population ranks among the highest worldwide. We aim to evaluate the prostate-specific antigen (PSA) kinetics after brachytherapy, which so far remains unknown in this population.


METHODS
From 2005 to 2013, 371 patients received (125)I brachytherapy of 145 Gy for early-stage prostate cancer. Eligibility criteria were cTNM ≤T2c, Gleason score ≤7, and initial PSA ≤15 ng/mL. Pretreatment androgen deprivation therapy was allowed. PSA bounce was defined as an increase of ≥0.4 ng/mL, lasting ≥6 months, followed by a decrease without any anticancer therapy. We examined PSA kinetics during followup.


RESULTS
For the 274 patients with at least 24 months followup, median age was 62 years old (range, 45-76). Initial PSA was <10 ng/mL in 244 and 10-15 ng/mL in 30 patients; 40 received androgen deprivation therapy. With a median followup of 50 months (range, 24-125), PSA declined continuously in 168 (61%) patients, bounced in 87 (31%), and initially declined and then rose in 22 (8%) patients. Among these latter patients, 18 presented clinical recurrence. Mean bounce intensity was 2.0 ng/mL (median, 1.2; range, 0.4-12.4). Bounces occurred in average 12 months after brachytherapy. Patients with bounce were significantly younger: mean age 59 vs. 63 years old in patients without bounce, p <0.001. Bounce was also significantly associated with the immediate post-brachytherapy PSA, mean 4.0 among bounce cases vs. 2.9 among non-bounce cases, p < 0.001. Bounce was not associated with recurrence.


CONCLUSIONS
PSA bounce in our African-Caribbean population seemed earlier and was more intense than described in other populations. Early increase of PSA should not be ascribed to treatment failure.
Department of Radiation Oncology, University Hospital of Martinique, France. Electronic address: nicolas.leduc.mail@gmail.com.
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N
Leduc
Department of Radiation Oncology, University Hospital of Martinique, France.
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V
Atallah
Department of Radiation Oncology, University Hospital of Martinique, France.
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M
Creoff
Department of Surgical Urology, University Hospital of Martinique, France.
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N
Rabia
Department of Surgical Urology, University Hospital of Martinique, France.
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T
Taouil
Department of Radiation Oncology, University Hospital of Martinique, France.
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P
Escarmant
Department of Radiation Oncology, University Hospital of Martinique, France.
V
V
Vinh-Hung
D000367:Age Factors; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D044383:Black People / Q000208:ethnology*; D001918:Brachytherapy; D017691:Caribbean Region / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000208:ethnology / Q000473:pathology / Q000532:radiotherapy*; D013997:Time Factors
D000726:Androgen Antagonists; D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
African-Caribbean; PSA bounce; Prostate cancer