PSA bounce is common following seed implantation for prostate cancer. It produces anxiety in men previously treated for prostate cancer and confounds the diagnosis of recurrence.

Young men with prostate cancer treated with brachytherapy have a significantly higher frequency, earlier onset and longer duration of PSA bounce than older men.

With this irradiation program cancer control, defined using the recurrence definition for radical prostatectomy, was durable with no further recurrence between 15.5 and 25 years of followup. This study also suggests that at least 15 years of followup are necessary to fully evaluate any prostate cancer treatment. Furthermore, if prostate specific antigen is less than 0.20 ng/ml 15 years after treatment, later recurrence should be unlikely.

Background. Because results of retropubic I‐125 implantation for prostate cancer have been poor, external beam radiation was added postimplant. Serum prostate specific antigen (PSA) was used to assess this approach of combined irradiation. Methods. Two hundred and thirty‐nine patients with clinical Stage T1 or T2 but surgically node‐negative prostate cancer were treated. Results were monitored by serial serum PSA evaluation. Positive clinical findings or a rising PSA level defined recurrent disease. Results. With a median follow‐up of 45 months (range, 24‐120 months), the Kaplan‐Meier projected disease free survival rate was 74% at 5 years and 66% at 10 years. Overall at a 60‐month minimum follow‐up, 77% of patients had a PSA of 0.5 ng/ml or less. This nadir level is highly predictive of a long term disease free survival, significantly better than pretreatment PSA, grade, or clinical Stage T1 or T2. Conclusions. The PSA‐monitored disease free survival rate after combination irradiation appears comparable with that after radical prostatectomy and perhaps superior to that after external‐beam radiation. This effect was achieved even though lower‐than‐usual doses of radiation from both sources were administered. The combination of an I‐125 implant followed by external‐beam radiation produces high doses within the prostate and, to a lesser extent, in the periprostatic tissue. Additive and synergistic effects from simultaneous irradiation may be responsible for these results.

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The definition of freedom from prostate cancer significantly affects treatment results. A standard definition is needed and a PSA cutoff of 0.2 ng./ml. is suggested as the standard for all curative treatments for localized prostate cancer.

Intermediate treatment outcome analysis of modern simultaneous radiation supports the principles of radiation dose intensification for intracapsular disease plus the treatment of potential microscopic capsular penetration.