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PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation.
Brachytherapy. 2010 Apr-Jun; 9(2):137-44.B

Abstract

PURPOSE

To assess the impact of PSA bounce (PB) on biochemical failure (BF) and clinical failure (CF) in brachytherapy patients treated with or without neoadjuvant androgen deprivation (AD).

METHODS AND MATERIALS

From 1987 to 2003, 691 patients with clinical stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) and high-dose-rate (HDR) brachytherapy boost (n=407), HDR brachytherapy alone (n=93), or permanent seed implant (n=191). Three hundred seventeen patients (46%) received neoadjuvant/adjuvant AD with RT. BF was scored using 3 definitions (ASTRO--3 rises, nadir+2 ng/ml, and threshold 3 ng/ml) based on current and absolute nadir (AN) methodologies. PB was defined as any increase in PSA followed by a decrease to the prior baseline or lower. The median followup was 4.0 years.

RESULTS

Forty-six patients (7%) experienced CF at 5 years. PB of >or=0.1, >or=1.0, and >or=2.0 ng/ml at any time after RT occurred in 330 (48%), 60 (9%), and 22 patients (3%) respectively. The use of an AN definition reduced the likelihood of scoring PB as BF across all levels. The patients receiving AD experienced significantly longer bounce duration. Bounce <1.0 ng/ml showed no association with CF. For bounce >or=1.0 ng/ml, 10% demonstrated CF vs. 6% without bounce of this amplitude (p=0.27). Bounces >or=1.0 ng/ml were more likely to be scored as BFs for definitions based on current nadir (3 rises: 20% vs. 13%, nadir+2: 43% vs. 11%, 3 at/after nadir: 57% vs. 12%) than those based on AN (3 rises: 8% vs. 10%, nadir+2: 18% vs. 11%, 3 at/after nadir: 13% vs. 11%).

CONCLUSIONS

Bounces >or=1.0 ng/ml are rare after brachytherapy with or without neoadjuvant AD, occurring in less than 10% of patients. Low PBs have little impact on BF, but as PB amplitude increases, the BF rate increases. BF definitions based on AN are less sensitive to PB after brachytherapy.

Authors+Show Affiliations

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19850537

Citation

McGrath, Samuel D., et al. "PSA Bounce After Prostate Brachytherapy With or Without Neoadjuvant Androgen Deprivation." Brachytherapy, vol. 9, no. 2, 2010, pp. 137-44.
McGrath SD, Antonucci JV, Fitch DL, et al. PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation. Brachytherapy. 2010;9(2):137-44.
McGrath, S. D., Antonucci, J. V., Fitch, D. L., Ghilezan, M., Gustafson, G. S., Vicini, F. A., Martinez, A. A., & Kestin, L. L. (2010). PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation. Brachytherapy, 9(2), 137-44. https://doi.org/10.1016/j.brachy.2009.07.005
McGrath SD, et al. PSA Bounce After Prostate Brachytherapy With or Without Neoadjuvant Androgen Deprivation. Brachytherapy. 2010 Apr-Jun;9(2):137-44. PubMed PMID: 19850537.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PSA bounce after prostate brachytherapy with or without neoadjuvant androgen deprivation. AU - McGrath,Samuel D, AU - Antonucci,J Vito, AU - Fitch,Dwight L, AU - Ghilezan,Michel, AU - Gustafson,Gary S, AU - Vicini,Frank A, AU - Martinez,Alvaro A, AU - Kestin,Larry L, Y1 - 2009/10/21/ PY - 2009/03/10/received PY - 2009/06/27/revised PY - 2009/07/01/accepted PY - 2009/10/24/entrez PY - 2009/10/24/pubmed PY - 2010/7/1/medline SP - 137 EP - 44 JF - Brachytherapy JO - Brachytherapy VL - 9 IS - 2 N2 - PURPOSE: To assess the impact of PSA bounce (PB) on biochemical failure (BF) and clinical failure (CF) in brachytherapy patients treated with or without neoadjuvant androgen deprivation (AD). METHODS AND MATERIALS: From 1987 to 2003, 691 patients with clinical stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) and high-dose-rate (HDR) brachytherapy boost (n=407), HDR brachytherapy alone (n=93), or permanent seed implant (n=191). Three hundred seventeen patients (46%) received neoadjuvant/adjuvant AD with RT. BF was scored using 3 definitions (ASTRO--3 rises, nadir+2 ng/ml, and threshold 3 ng/ml) based on current and absolute nadir (AN) methodologies. PB was defined as any increase in PSA followed by a decrease to the prior baseline or lower. The median followup was 4.0 years. RESULTS: Forty-six patients (7%) experienced CF at 5 years. PB of >or=0.1, >or=1.0, and >or=2.0 ng/ml at any time after RT occurred in 330 (48%), 60 (9%), and 22 patients (3%) respectively. The use of an AN definition reduced the likelihood of scoring PB as BF across all levels. The patients receiving AD experienced significantly longer bounce duration. Bounce <1.0 ng/ml showed no association with CF. For bounce >or=1.0 ng/ml, 10% demonstrated CF vs. 6% without bounce of this amplitude (p=0.27). Bounces >or=1.0 ng/ml were more likely to be scored as BFs for definitions based on current nadir (3 rises: 20% vs. 13%, nadir+2: 43% vs. 11%, 3 at/after nadir: 57% vs. 12%) than those based on AN (3 rises: 8% vs. 10%, nadir+2: 18% vs. 11%, 3 at/after nadir: 13% vs. 11%). CONCLUSIONS: Bounces >or=1.0 ng/ml are rare after brachytherapy with or without neoadjuvant AD, occurring in less than 10% of patients. Low PBs have little impact on BF, but as PB amplitude increases, the BF rate increases. BF definitions based on AN are less sensitive to PB after brachytherapy. SN - 1873-1449 UR - https://www.unboundmedicine.com/medline/citation/19850537/PSA_bounce_after_prostate_brachytherapy_with_or_without_neoadjuvant_androgen_deprivation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1538-4721(09)00278-5 DB - PRIME DP - Unbound Medicine ER -