Prediction of PSA bounce after permanent prostate brachytherapy for localized prostate cancer

Kanai, Kunimitsu; Nakashima, Jun; Sugawara, Akitomo; Shigematsu, Naoyuki; Nagata, Hirohiko; Kikuchi, Eiji; Miyajima, Akira; Nakagawa, Ken; Kubo, Atsushi; Oya, Mototsugu

doi:10.1007/s10147-009-0909-0

Cited by 14 publications

(14 citation statements)

References 25 publications

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“…In this group, %UD90, UD90 and %UD30 showed a significant difference between patients with PSA bounce and those without PSA bounce, while age showed a marginal difference ( p = 0.06). Previous studies have reported that age, D90, isotope, and prostate volume were the significant predictive factors of PSA bounce [3-9]. On the other hand, age, %UD90 and %UD30 were significant predictive parameters of PSA bounce by univariate analysis using a Cox proportional regression hazard model in this study.…”

Section: Discussionsupporting

confidence: 43%

“…Reportedly, 17% to 62% of patients are diagnosed with PSA bounce using several definitions [1-10]. The median time to PSA bounce varied from 15 months to 26 months [1,2,4,6,7,9,10]. The median height of PSA bounce was 0.4 ng/mL to 0.8 ng/mL [1,2,4,6-9].…”

Section: Discussionmentioning

confidence: 99%

“…The median time to PSA bounce varied from 15 months to 26 months [1,2,4,6,7,9,10]. The median height of PSA bounce was 0.4 ng/mL to 0.8 ng/mL [1,2,4,6-9]. The median duration of PSA bounce was 6.8 months to 22.5 months [2,3,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Seventeen to 62% of patients who underwent LDR-brachytherapy showed a PSA bounce during the first 3 years after LDR-brachytherapy [1-10]. The incidence of PSA bounce in Japanese patients is reportedly similar to that in American patients [8,9]. …”

Section: Introductionmentioning

confidence: 99%

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Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

et al. 2012

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BackgroundTo clarify the significant clinicopathological and postdosimetric parameters to predict PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer.MethodsWe studied 200 consecutive patients who received LDR-brachytherapy between July 2004 and November 2008. Of them, 137 patients did not receive neoadjuvant or adjuvant androgen deprivation therapy. One hundred and forty-two patients were treated with LDR-brachytherapy alone, and 58 were treated with LDR-brachytherapy in combination with external beam radiation therapy. The cut-off value of PSA bounce was 0.1 ng/mL. The incidence, time, height, and duration of PSA bounce were investigated. Clinicopathological and postdosimetric parameters were evaluated to elucidate independent factors to predict PSA bounce in hormone-naïve patients who underwent LDR-brachytherapy alone.ResultsFifty patients (25%) showed PSA bounce and 10 patients (5%) showed PSA failure. The median time, height, and duration of PSA bounce were 17 months, 0.29 ng/mL, and 7.0 months, respectively. In 103 hormone-naïve patients treated with LDR-brachytherapy alone, and univariate Cox proportional regression hazard model indicated that age and minimal percentage of the dose received by 30% and 90% of the urethra were independent predictors of PSA bounce. With a multivariate Cox proportional regression hazard model, minimal percentage of the dose received by 90% of the urethra was the most significant parameter of PSA bounce.ConclusionsMinimal percentage of the dose received by 90% of the urethra was the most significant predictor of PSA bounce in hormone-naïve patients treated with LDR-brachytherapy alone.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

et al. 2012

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“…Toledano et al reported similar results with a higher threshold, 200 Gy [32,33]. Recently, Kanai et al found in a multivariate analysis that high D90 was correlated with bounce occurrence [17]. Some have speculated that high doses could lead to a greater likelihood of inflammatory and thus to PSA bounce.…”

Section: Discussionmentioning

confidence: 88%

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

et al. 2012

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PurposeTo evaluate predictive factors for PSA bounce after 125I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses.Materials and methodsMen 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.Results198 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).ConclusionHigh 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.

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Outcomes after prostate brachytherapy are even better than predicted

Frank

Levy

Vulpen

et al. 2011

Cancer

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BACKGROUND: During the first 3 years after prostate cancer treatment with radiation therapy, benign prostate-specific antigen (PSA) bounces are difficult for clinicians to distinguish from a biochemical recurrence, which can result in unnecessary interventions and erroneous predictions of outcomes. The objective of this study was to evaluate a commonly used PSA failure definition in a multinational, multi-institutional study after monotherapy with prostate brachytherapy. METHODS: Participants were selected from 2919 men who underwent permanent prostate brachytherapy at the University Medical Center Utrecht, Princess Margaret Hospital, or Seattle Prostate Institute between 1998 and 2006. Inclusion required not having received androgen-deprivation therapy and having at least 30 months of follow-up. Failure was defined as any post-treatment use of hormone therapy, clinical relapse, or prostogramdefined biochemical (PSA) failure. Cases in which the nomogram predicted biochemical failure were evaluated at each institution to verify biochemical status over time and the actual clinical outcome at 5 years. RESULTS: The median follow-up for the 1816 patients was 5.2 years. Concordance between the prostogram-predicted and actual outcomes, as measured by the Harrell c statistic, was 0.655 (95% confidence interval [CI], 0.536-0.774; P ¼ .010) for the Princess Margaret group, 0.493 (95% CI, 0.259-0.648; P ¼ .955) for the Seattle group, and 0.696 (95% CI, 0.648-0.744, P < .001) for the Utrecht group. The overall mean difference in biochemical recurrence-free survival at 5 years between actual outcomes and prostogram-defined outcomes was 9.2% (95% CI, 7.7%-10.6%). The total numbers of prostogram-defined and actual biochemical failures were 312 and 157, respectively (P ¼ .001). CONCLUSIONS: The widely used prostogram could not adequately distinguish a benign PSA bounce from a biochemical recurrence after prostate brachytherapy and could not be used to counsel patients about their predicted outcomes after treatment. The authors conclude that, to avoid unnecessary active interventions after treatment, clinicians should monitor PSA levels for at least 3 years and provide reassurance to patients that a PSA rise during this time is common and may not indicate a treatment failure. Cancer 2012;118:839-

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Prediction of PSA bounce after permanent prostate brachytherapy for localized prostate cancer

Abstract: PSA bounce is not a rare phenomenon after prostate brachytherapy. It is more common in younger patients and patients receiving higher doses of radiation.

Cited by 14 publications

References 25 publications

Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer

Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

Outcomes after prostate brachytherapy are even better than predicted

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