Critz
FA, Williams WH,
Journal of Urology 2000 Apr;163(4):1085-9
PURPOSE: Prostate specific antigen (PSA) may temporarily increase
following radiotherapy for prostate cancer without signaling
cancer recurrence. We describe this phenomenon which is called PSA bounce.
MATERIALS AND METHODS: From 1984 to 1995, 779
stage T1T2N0 cancer cases were treated with simultaneous radiotherapy with a
125iodine prostate implant followed by external beam radiation. Median pretreatment PSA was 7.7 ng./ml. (range 0.3 to 188). PSA bounce was defined as an
increase of 0.1 ng./ml. or
greater above the preceding PSA level after simultaneous radiation followed by
a subsequent decrease below that level. Disease-free status was defined as the
ability to achieve and maintain posttreatment PSA 0.2
ng./ml. or less.
RESULTS: PSA bounce was observed in 35% of
men (273 of 779). Median time to PSA bounce was 18 months from the time of
implant and 92% of bounces were observed within 36 months. Median pre-bounce
PSA was 0.7 ng/ml. (range 0.1 to 8.9) and median
bounce height (increase above the pre-bounce level) was 0.4 ng./ml. (range 0.1 to 15.8). No distinguishing characteristics
were observed between men with PSA bounce and those with cancer recurrence, and
bounce had no prognostic significance relative to recurrence.
CONCLUSIONS: 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.