Prostate-Specific Antigen Bounce After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: A Multi-Institutional Pooled Analysis

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

“…Stock et al 5 and Toledano et al 3 also showed a signifi cantly more frequent bounce rate for patients with a D90 greater than 160 Gy and a D90 greater than 200 Gy, respectively. Though it has been reported that no association was found between D90 and PSA bounce in the multi-institutional study of Japanese patients, 12 it is possible to explain the association of a PSA bounce with higher doses of radiation. The increased rate of bounce seen with higher doses may be related to a greater likelihood of a radiation-induced infl ammatory reaction, as reported previously.…”

“…4,5,8,9,18,19 PSA bounce is a common phenomenon after brachytherapy. PSA bounce has previously been defi ned as an increase of more than 0.1 ng/ml, 3,5,8,9,12 followed by a subsequent decrease to less than that level; as an increase of more than 0.2 ng/ml, 2,3,6,7,11 followed by a decline or a minimal rise of 0.4 ng/ml 3,5,12 during a 3-6 month period, followed by a drop of any magnitude; or as a more than 35% elevation 5,12 in PSA compared with the most recent value, followed by a decline to a level at or less than the prebounce value. A rise of 0.1 ng/ml or 0.2 ng/ml may be too sensitive for clini- Table 2).…”

“…3,5,12 For each patient, PSA determinations were obtained at 3-month intervals after prostate brachytherapy implantation. The date of the fi rst increase in PSA was recorded for patients with multiple increases.…”

“…2 Approximately 15%-60% of hormone-naive patients show a temporary PSA elevation after brachytherapy. [2][3][4][5][6][7][8][9][10][11][12] It has been proposed that this PSA "bounce" is probably the result of some mechanism compromising membrane integrity; that is, radiation-induced prostatitis, in PSA-producing epithelium. In 1997, the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus conference recommended three consecutive increases in PSA levels after the nadir, with readings spaced 3-6 months apart, as the defi nition of biochemical failure.…”

Cost comparison of curative therapies for localized prostate cancer in Japan: a single-institution experience

“…8,9 After laws and ordinances regarding use of 125 I were enacted in Japan, 10,11 LDRBT began to be used in this country in 2003, and use of this therapy has rapidly increased. However, because no medical fee points were established for this new therapy, the fee for LDRBT was calculated on the basis of medical fee points applied to diseases such as tongue cancer (M004.4: small sealed-source radiotherapy, 2 000 points).…”