Prostate-Specific Antigen Bounce Following Stereotactic Body Radiation Therapy for Prostate Cancer

Abstract

Introduction: Prostate-specific antigen (PSA) bounce after brachytherapy has been well-documented. This phenomenon has also been identified in patients undergoing stereotactic body radiation therapy (SBRT). While the parameters that predict PSA bounce have been extensively studied in prostate brachytherapy patients, this study is the first to analyze the clinical and pathologic predictors of PSA bounce in prostate SBRT patients.Materials and Methods: Our institution has maintained a prospective database of patients undergoing SBRT for prostate cancer since 2006. Our study population includes patients between May 2006 and November 2011 who have at least 18 months of follow-up. All patients were treated using the CyberKnife treatment system. The prescription dose was 35–36.25 Gy in five fractions.Results: One hundred twenty patients were included in our study. Median PSA follow-up was 24 months (range 18–78 months). Thirty-four (28%) patients had a PSA bounce. The median time to PSA bounce was 9 months, and the median bounce size was 0.50 ng/mL. On univariate analysis, only younger age (p = 0.011) was shown to be associated with an increased incidence of PSA bounce. Other patient factors, including race, prostate size, prior treatment by hormones, and family history of prostate cancer, did not predict PSA bounces. None of the tumor characteristics studied, including Gleason score, pre-treatment PSA, T-stage, or risk classification by NCCN guidelines, were associated with increased incidence of PSA bounces. Younger age was the only statistically significant predictor of PSA bounce on multivariate analysis (OR = 0.937, p = 0.009).Conclusion: PSA bounce, which has been reported after prostate brachytherapy, is also seen in a significant percentage of patients after CyberKnife SBRT. Close observation rather than biopsy can be considered for these patients. Younger age was the only factor that predicted PSA bounce.

Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

“…High prevalence of PSA bounce among younger patients was consistent with previous reports on SBRT [15,16] and brachytherapy [17]. The mechanisms underlying PSA bounce and its association with age have not been fully elucidated.…”

“…CIRT was initiated on day 0. PSA was measured at 1,2,3,6,9,12,15,18,21,24,30,36,42,48,54, and 60 months post-CIRT at Gunma University Hospital. PSA bounce was defined as an increase in PSA over a cutoff followed by a spontaneous decrease to or below the pre-bounce nadir [17].…”

Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

“…McBride et al [5] found that the mean age of those who experienced a bounce was significantly younger than those who did not. Vu et al [21] reported that younger age was the only factor that predicted PSA bounce following SBRT for prostate cancer. Park et al [22] showed that only pretreatment PSA level was associated with increased risk of PSA bounce.…”

Prostate‐specific antigen kinetics following hypofractionated stereotactic body radiotherapy versus conventionally fractionated external beam radiotherapy for low‐ and intermediate‐risk prostate cancer

“…Vu et al . reported that younger age was the only factor that predicted PSA bounce following SBRT for prostate cancer . Park et al .…”