Prostate-specific antigen bounce in patients treated before 60 years old by iodine 125 brachytherapy for prostate cancer is frequent and not a prognostic factor

• Published in: Brachytherapy Vol. 17; no. 6; pp. 888 - 894
• Main Authors: Charret, J., Baumann, A.S., Eschwege, P., Moreau, J.L., Bernier, V., Falk, A.T., Salleron, J., Peiffert, D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - mortality; Adenocarcinoma - radiotherapy; Age Factors; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - methods; Follow-Up Studies; Humans; Incidence; Iodine Radioisotopes - administration & dosage; Iodine Radioisotopes - adverse effects; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Prognosis; Prostate cancer; Prostate-Specific Antigen - analysis; Prostatic Neoplasms - blood; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; PSA bounce; Retrospective Studies; Survival Analysis; Treatment Failure; Young people; Young people; Brachytherapy; Prostate cancer; PSA bounce
• ISSN: 1538-4721; 1873-1449
• DOI: 10.1016/j.brachy.2018.07.011

The only prognostic factor of prostate-specific antigen (PSA) bounce in prostate cancer found in several studies is young age but has never been specifically studied in this subset of patients for long-term results. Bounce characteristics, histological, clinical, and dosimetric data in young patients were analyzed, as well as their impact on toxicity and survival. This retrospective study included patients aged ≤60 years treated with exclusive iodine 125 brachytherapy with low or intermediary prostate adenocarcinoma during 1999–2014. Exclusion criteria were a follow-up of ≤24 months. PSA bounce was defined as a ≥0.2-ng/mL increase above the interval PSA nadir, followed by a decrease to nadir or below. This study analyzed 179 patients. Median age was 56 years (46–59 years). The median follow-up was 79 months (54; 123). The bounce incidence was 56.8% (49.6%; 64.2%) at 5 years, inversely proportional to positive/total biopsies ratio (HR 0.98, 95% CI [0.97, 0.99]). Incidence of biochemical failure was 1.2%, 95% CI (0.3%; 4.7%), at 5 years with no difference between the bounce and no-bounce group (HR 0.96, 95% CI [0.25; 3.58]). Bounce is an unfavorable prognostic factor for grade two and three urinary toxicities 6.67 (4.14; 10.76) (p < 0.001). PSA bounce is common in young people after brachytherapy. It should be monitored without starting an inadequate and sometimes invasive relapse checkup or a relapse treatment.