Skip to main content

PSA After Radiotherapy: PSA Bounce and Biochemical Failure

  • Chapter
  • First Online:
Principles and Practice of Urooncology

Abstract

Prostate cancer is one of the major health problems in the world. Active surveillance (AS), radical prostatectomy (RP) or radiotherapy (RT) options can be selected in patients with localized prostate cancer according to risk groups. RT can be given as external beam therapy (EBT) or as brachytherapy (BRT). EBT can be delivered by three-dimensional conformal RT (3BKRT) or intensity modulated RT (IMRT) with conventional fractionation, hypofractionated RT (HFRT), stereotactic body RT (SBRT) and proton treatment. High-dose rate (HDR) or low-dose rate (LDR) BRT can be used as a sole treatment modality or as a combined treatment modality with EBT. Treatment success after local treatment is often evaluated by “biochemical failure.” Approximately one-third of patients undergoing RP and 20–30% of patients treated with EBT and hormonal treatment show local recurrence or biochemical failures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467–79.

    Article  CAS  PubMed  Google Scholar 

  2. Keto CJ, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, et al. Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database. Eur Urol. 2014;65(3):620–7.

    Article  CAS  PubMed  Google Scholar 

  3. Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65(4):965–74.

    Article  PubMed  Google Scholar 

  4. Willett CG, Zietman AL, Shipley WU, Coen JJ. The effect of pelvic radiation therapy on serum levels of prostate specific antigen. J Urol. 1994;151(6):1579–81.

    Article  CAS  PubMed  Google Scholar 

  5. Crook J, Gillan C, Yeung I, Austen L, McLean M, Lockwood G. PSA kinetics and PSA bounce following permanent seed prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2007;69(2):426–33.

    Article  CAS  PubMed  Google Scholar 

  6. Ray ME, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. 2006;64(4):1140–50.

    Article  PubMed  Google Scholar 

  7. Pickles T. British Columbia cancer agency prostate cohort outcomes I. Prostate-specific antigen (PSA) bounce and other fluctuations: which biochemical relapse definition is least prone to PSA false calls? An analysis of 2030 men treated for prostate cancer with external beam or brachytherapy with or without adjuvant androgen deprivation therapy. Int J Radiat Oncol Biol Phys. 2006;64(5):1355–9.

    Article  PubMed  Google Scholar 

  8. Zietman AL, Christodouleas JP, Shipley WU. PSA bounces after neoadjuvant androgen deprivation and external beam radiation: impact on definitions of failure. Int J Radiat Oncol Biol Phys. 2005;62(3):714–8.

    Article  PubMed  Google Scholar 

  9. Rosser CJ, Kuban DA, Levy LB, Chichakli R, Pollack A, Lee AK, et al. Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer. J Urol. 2002;168(5):2001–5.

    Article  CAS  PubMed  Google Scholar 

  10. Wallner KE, Dattoli MJ. Prostate brachytherapy made complicated. Seattle, WA: Smart Medicine Press; 1997.

    Google Scholar 

  11. Critz FA, Williams WH, Benton JB, Levinson AK, Holladay CT, Holladay DA. Prostate specific antigen bounce after radioactive seed implantation followed by external beam radiation for prostate cancer. J Urol. 2000;163(4):1085–9.

    Article  CAS  PubMed  Google Scholar 

  12. Zwahlen DR, Smith R, Andrianopoulos N, Matheson B, Royce P, Millar JL. Prostate-specific antigen bounce after permanent iodine-125 prostate brachytherapy – an Australian analysis. Int J Radiat Oncol Biol Phys. 2011;79(1):179–87.

    Article  CAS  PubMed  Google Scholar 

  13. Ciezki JP, Reddy CA, Garcia J, Angermeier K, Ulchaker J, Mahadevan A, et al. PSA kinetics after prostate brachytherapy: PSA bounce phenomenon and its implications for PSA doubling time. Int J Radiat Oncol Biol Phys. 2006;64(2):512–7.

    Article  CAS  PubMed  Google Scholar 

  14. Toledano A, Chauveinc L, Flam T, Thiounn N, Solignac S, Timbert M, et al. PSA bounce after permanent implant prostate brachytherapy may mimic a biochemical failure: a study of 295 patients with a minimum 3-year follow-up. Brachytherapy. 2006;5(2):122–6.

    Article  PubMed  Google Scholar 

  15. Hinnen KA, Monninkhof EM, Battermann JJ, van Roermund JG, Frank SJ, van Vulpen M. Prostate specific antigen bounce is related to overall survival in prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2012;82(2):883–8.

    Article  PubMed  Google Scholar 

  16. Caloglu M, Ciezki JP, Reddy CA, Angermeier K, Ulchaker J, Chehade N, et al. PSA bounce and biochemical failure after brachytherapy for prostate cancer: a study of 820 patients with a minimum of 3 years of follow-up. Int J Radiat Oncol Biol Phys. 2011;80(3):735–41.

    Article  PubMed  Google Scholar 

  17. Cavanagh W, Blasko JC, Grimm PD, Sylvester JE. Transient elevation of serum prostate-specific antigen following (125)I/(103)Pd brachytherapy for localized prostate cancer. Semin Urol Oncol. 2000;18(2):160–5.

    CAS  PubMed  Google Scholar 

  18. Gaztanaga M, Crook J. Interpreting a rising prostate-specific antigen after brachytherapy for prostate cancer. Int J Urol. 2013;20(2):142–7.

    Article  CAS  PubMed  Google Scholar 

  19. Thames H, Kuban D, Levy L, Horwitz EM, Kupelian P, Martinez A, et al. Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995. Int J Radiat Oncol Biol Phys. 2003;57(4):929–43.

    Article  CAS  PubMed  Google Scholar 

  20. Hanlon AL, Pinover WH, Horwitz EM, Hanks GE. Patterns and fate of PSA bouncing following 3D-CRT. Int J Radiat Oncol Biol Phys. 2001;50(4):845–9.

    Article  CAS  PubMed  Google Scholar 

  21. Sheinbein C, Teh BS, Mai WY, Grant W, Paulino A, Butler EB. Prostate-specific antigen bounce after intensity-modulated radiotherapy for prostate cancer. Urology. 2010;76(3):728–33.

    Article  PubMed  Google Scholar 

  22. Rosser CJ, Kamat AM, Wang X, Do KA, Sanchez-Ortiz RF, Kuban DA, et al. Is patient age a factor in the occurrence of prostate-specific antigen bounce phenomenon after external beam radiotherapy for prostate cancer? Urology. 2005;66(2):327–31.

    Article  PubMed  Google Scholar 

  23. Akyol F, Ozyigit G, Selek U, Karabulut E. PSA bouncing after short term androgen deprivation and 3D-conformal radiotherapy for localized prostate adenocarcinoma and the relationship with the kinetics of testosterone. Eur Urol. 2005;48(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  24. Naghavi AO, Strom TJ, Nethers K, Cruz AA, Figura NB, Shrinath K, et al. Clinical implications of a prostate-specific antigen bounce after radiation therapy for prostate cancer. Int J Clin Oncol. 2015;20(3):598–604.

    Article  CAS  PubMed  Google Scholar 

  25. Reis LO, Sanches BC, Zani EL, Castilho LN, Monti CR. PSA-nadir at 1 year as a sound contemporary prognostic factor for low-dose-rate iodine-125 seeds brachytherapy. World J Urol. 2014;32(3):753–9.

    Article  CAS  PubMed  Google Scholar 

  26. Mehta NH, Kamrava M, Wang PC, Steinberg M, Demanes J. Prostate-specific antigen bounce after high-dose-rate monotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2013;86(4):729–33.

    Article  CAS  PubMed  Google Scholar 

  27. Merrick GS, Butler WM, Wallner KE, Lief JH, Hinerman-Mulroy A, Galbreath RW. Prostate-specific antigen (PSA) velocity and benign prostate hypertrophy predict for PSA spikes following prostate brachytherapy. Brachytherapy. 2003;2(3):181–8.

    Article  PubMed  Google Scholar 

  28. Pickles T, Duncan GG, Kim-sing C, McKenzie MR, Morris WJ. PSA relapse definitions – the vancouver rules show superior predictive power. Int J Radiat Oncol Biol Phys. 1999;43(3):699–700.

    Article  CAS  PubMed  Google Scholar 

  29. Hanlon AL, Hanks GE. Scrutiny of the ASTRO consensus definition of biochemical failure in irradiated prostate cancer patients demonstrates its usefulness and robustness. American society for therapeutic radiology and oncology. Int J Radiat Oncol Biol Phys. 2000;46(3):559–66.

    Article  CAS  PubMed  Google Scholar 

  30. Kamat AM, Rosser CJ, Levy LB, Chichakli R, Lee AK, Cheung MR, et al. Rise in serum PSA of 1.5 ng/mL above 24-month nadir after external beam radiotherapy is predictive of biochemical failure. Urology. 2004;63(6):1132–7.

    Article  PubMed  Google Scholar 

  31. American Society for Therapeutic Radiology and Oncology Consensus Panel. Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys. 1997;37(5):1035–41.

    Google Scholar 

  32. Buyyounouski MK, Pickles T, Kestin LL, Allison R, Williams SG. Validating the interval to biochemical failure for the identification of potentially lethal prostate cancer. J Clin Oncol. 2012;30(15):1857–63.

    Article  PubMed  Google Scholar 

  33. Kestin LL, Vicini FA, Martinez AA. Practical application of biochemical failure definitions: what to do and when to do it. Int J Radiat Oncol Biol Phys. 2002;53(2):304–15.

    Article  PubMed  Google Scholar 

  34. Sandler HM, Dunn RL, McLaughlin PW, Hayman JA, Sullivan MA, Taylor JM. Overall survival after prostate-specific-antigen-detected recurrence following conformal radiation therapy. Int J Radiat Oncol Biol Phys. 2000;48(3):629–33.

    Article  CAS  PubMed  Google Scholar 

  35. Kuban DA, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. Long-term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys. 2003;57(4):915–28.

    Article  PubMed  Google Scholar 

  36. Khuntia D, Reddy CA, Mahadevan A, Klein EA, Kupelian PA. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in the prostate-specific antigen era: what should we expect? Cancer. 2004;100(6):1283–92.

    Article  PubMed  Google Scholar 

  37. Zagars GK, Pollack A, von Eschenbach AC. Prognostic factors for clinically localized prostate carcinoma: analysis of 938 patients irradiated in the prostate specific antigen era. Cancer. 1997;79(7):1370–80.

    Article  CAS  PubMed  Google Scholar 

  38. Potters L, Morgenstern C, Calugaru E, Fearn P, Jassal A, Presser J, et al. 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol. 2005;173(5):1562–6.

    Article  PubMed  Google Scholar 

  39. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.

    Article  PubMed  Google Scholar 

  40. Zelefsky MJ, Ben-Porat L, Scher HI, Chan HM, Fearn PA, Fuks ZY, et al. Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer. J Clin Oncol. 2005;23(4):826–31.

    Article  PubMed  Google Scholar 

  41. Zhou P, Chen MH, McLeod D, Carroll PR, Moul JW, D’Amico AV. Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol. 2005;23(28):6992–8.

    Article  PubMed  Google Scholar 

  42. Zagars GK, Pollack A, Kavadi VS, von Eschenbach AC. Prostate-specific antigen and radiation therapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1995;32(2):293–306.

    Article  CAS  PubMed  Google Scholar 

  43. D’Amico AV, Moul JW, Carroll PR, Sun L, Lubeck D, Chen MH. Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst. 2003;95(18):1376–83.

    Article  PubMed  Google Scholar 

  44. Zietman AL, Tibbs MK, Dallow KC, Smith CT, Althausen AF, Zlotecki RA, et al. Use of PSA nadir to predict subsequent biochemical outcome following external beam radiation therapy for T1-2 adenocarcinoma of the prostate. Radiother Oncol. 1996;40(2):159–62.

    Article  CAS  PubMed  Google Scholar 

  45. Alcantara P, Hanlon A, Buyyounouski MK, Horwitz EM, Pollack A. Prostate-specific antigen nadir within 12 months of prostate cancer radiotherapy predicts metastasis and death. Cancer. 2007;109(1):41–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Crook JM, Choan E, Perry GA, Robertson S, Esche BA. Serum prostate-specific antigen profile following radiotherapy for prostate cancer: implications for patterns of failure and definition of cure. Urology. 1998;51(4):566–72.

    Article  CAS  PubMed  Google Scholar 

  47. Taylor JM, Yu M, Sandler HM. Individualized predictions of disease progression following radiation therapy for prostate cancer. J Clin Oncol. 2005;23(4):816–25.

    Article  PubMed  Google Scholar 

  48. Vigna-Taglianti R, Russi EG, Boriano A, Gianello L, Denaro N, Lucio F, et al. Reliability of prostate-specific antigen-marker in determining biochemical failure during the first 2 years after external beam radiation therapy and hormone therapy in patients with non-operated prostate cancer. Urol Oncol. 2014;32(1):30 e1–7.

    Article  Google Scholar 

  49. Thompson A, Keyes M, Pickles T, Palma D, Moravan V, Spadinger I, et al. Evaluating the Phoenix definition of biochemical failure after (125)I prostate brachytherapy: can PSA kinetics distinguish PSA failures from PSA bounces? Int J Radiat Oncol Biol Phys. 2010;78(2):415–21.

    Article  PubMed  Google Scholar 

  50. Mitchell DM, Swindell R, Elliott T, Wylie JP, Taylor CM, Logue JP. Analysis of prostate-specific antigen bounce after I(125) permanent seed implant for localised prostate cancer. Radiother Oncol. 2008;88(1):102–7.

    Article  PubMed  Google Scholar 

  51. Stone NN. Editorial Comment from Dr Stone to interpreting a rising prostate-specific antigen after brachytherapy for prostate cancer. Int J Urol. 2013;20(2):148.

    Article  PubMed  Google Scholar 

  52. Zaorsky NG, Yamoah K, Thakur ML, Trabulsi EJ, Showalter TN, Hurwitz MD, et al. A paradigm shift from anatomic to functional and molecular imaging in the detection of recurrent prostate cancer. Future Oncol. 2014;10(3):457–74.

    Article  CAS  PubMed  Google Scholar 

  53. Casalino DD, Remer EM, Arellano RS, Bishoff JT, Coursey CA, Dighe M, et al. ACR Appropriateness Criteria(R) posttreatment follow-up of prostate cancer. J Am Coll Radiol. 2011;8(12):863–71.

    Article  PubMed  Google Scholar 

  54. Crook J, Malone S, Perry G, Bahadur Y, Robertson S, Abdolell M. Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys. 2000;48(2):355–67.

    Article  CAS  PubMed  Google Scholar 

  55. Punnen S, Cooperberg MR, D’Amico AV, Karakiewicz PI, Moul JW, Scher HI, et al. Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2013;64(6):905–15.

    Article  PubMed  Google Scholar 

  56. Umbehr MH, Muntener M, Hany T, Sulser T, Bachmann LM. The role of 11C-choline and 18F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis. Eur Urol. 2013;64(1):106–17.

    Article  PubMed  Google Scholar 

  57. Lopez Torrecilla J, Hervas A, Zapatero A, Gomez Caamano A, Macias V, Herruzo I, et al. Uroncor consensus statement: management of biochemical recurrence after radical radiotherapy for prostate cancer: from biochemical failure to castration resistance. Rep Pract Oncol Radiother. 2015;20(4):259–72.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Gomez-Veiga F, Marino A, Alvarez L, Rodriguez I, Fernandez C, Pertega S, et al. Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy. BJU Int. 2012;109(Suppl 1):17–21.

    Article  PubMed  Google Scholar 

  59. Pisters LL, Leibovici D, Blute M, Zincke H, Sebo TJ, Slezak JM, et al. Locally recurrent prostate cancer after initial radiation therapy: a comparison of salvage radical prostatectomy versus cryotherapy. J Urol. 2009;182(2):517–25; discussion 25–7.

    Article  PubMed  Google Scholar 

  60. Darwish OM, Raj GV. Management of biochemical recurrence after primary localized therapy for prostate cancer. Front Oncol. 2012;2:48.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ismail M, Ahmed S, Kastner C, Davies J. Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients. BJU Int. 2007;100(4):760–4.

    Article  PubMed  Google Scholar 

  62. Studer UE, Whelan P, Albrecht W, Casselman J, de Reijke T, Hauri D, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol. 2006;24(12):1868–76.

    Article  PubMed  Google Scholar 

  63. Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, et al. Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol. 2013;8:58.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Katz AJ, Santoro M, Diblasio F, Ashley R. Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years. Radiat Oncol. 2013;8:118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. King CR, Brooks JD, Gill H, Presti JC Jr. Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):877–82.

    Article  PubMed  Google Scholar 

  66. Anwar M, Weinberg V, Chang AJ, Hsu IC, Roach M 3rd, Gottschalk A. Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir. Radiat Oncol. 2014;9:42.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kole TP, Chen LN, Obayomi-Davies O, Kim JS, Lei S, Suy S, et al. Prostate specific antigen kinetics following robotic stereotactic body radiotherapy for localized prostate cancer. Acta Oncol. 2015;54(6):832–8.

    Article  CAS  PubMed  Google Scholar 

  68. CC V, Haas JA, Katz AE, Witten MR. Prostate-specific antigen bounce following stereotactic body radiation therapy for prostate cancer. Front Oncol. 2014;4:8.

    Google Scholar 

  69. Kim HJ, Phak JH, Kim WC. Prostate-specific antigen kinetics after stereotactic body radiotherapy as monotherapy or boost after whole pelvic radiotherapy for localized prostate cancer. Prostate Int. 2015;3(4):118–22.

    Article  PubMed  PubMed Central  Google Scholar 

  70. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969–74.

    Article  PubMed  Google Scholar 

  71. Ozyigit G, Hurmuz P, Akyol F. Comparison of two fractionation schemes in prostate cancer patients treated with robotic SBRT. Proceedings of ESTRO 36; 2017 May 5–9; Vienna, Austria.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gokhan Ozyigit M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Akyol, F., Gultekin, M., Yazici, G., Hurmuz, P., Sari, S.Y., Ozyigit, G. (2017). PSA After Radiotherapy: PSA Bounce and Biochemical Failure. In: Ozyigit, G., Selek, U. (eds) Principles and Practice of Urooncology. Springer, Cham. https://doi.org/10.1007/978-3-319-56114-1_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56114-1_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56113-4

  • Online ISBN: 978-3-319-56114-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics