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Distinguishing prostate-specific antigen bounces from biochemical failure after low-dose-rate prostate brachytherapy.

By:
Contributors: Nawaid Usmani, MD, FRCPC, Sunita Ghosh, PhD
J Contemp Brachytherapy. 2014 Oct;6(3):247-53. doi: 10.5114/jcb.2014.45093. Epub 2014 Sep 5.

Abstract

PURPOSE:

The purpose of this study was to characterize benign prostate-specific antigen (PSA) bounces of at least 2.0 ng/mL and biochemical failure as defined by the Phoenix definition after prostate brachytherapy at our institution, and to investigate distinguishing features between three outcome groups: patients experiencing a benign PSA bounce, biochemical failure, or neither.

MATERIAL AND METHODS:

Five hundred and thirty consecutive men treated with low-dose-rate brachytherapy with follow-up of at least 3 years were divided into outcome groups experiencing bounce, failure, or neither. A benign bounce was defined as a rise of at least 2.0 ng/mL over the pre-rise nadir followed by a decline to 0.5 ng/mL or below, without intervention. Patient and tumor characteristics, treatment variables, and PSA kinetics were analyzed between groups.

RESULTS:

Thirty-two (6.0%) men experienced benign bounces and 47 (8.9%) men experienced failure. Men experiencing a bounce were younger (p = 0.01), had a higher 6-month PSA level (p = 0.03), and took longer to reach a final nadir (p < 0.01). Compared to the failure group, men with bounce had a lower pre-treatment PSA level (p = 0.01) and experienced a rise of at least 2.0 ng/mL that occurred sooner after the implant (p < 0.01) with a faster PSA doubling time (p = 0.01). Only time to PSA rise independently differentiated between bounce and failure (p < 0.01), with a benign bounce not being seen after 36 months post-treatment. Prostate-specific antigen levels during a bounce reached levels as high as 12.6 ng/mL in this cohort, and in some cases took over 5 years to decline to below 0.5 ng/mL.

CONCLUSIONS:

Although there is substantial overlap between the features of benign PSA bounces and failure, physicians may find it useful to evaluate the timing, absolute PSA level, initial response to treatment, and rate of rise when contemplating management for a PSA rise after low-dose-rate brachytherapy.

PubMed

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APCaRI 2016 Fall Symposium

On Oct. 20-21, 2016, APCaRI will celebrate its 7th research meeting at the Banff Park Lodge, Alberta.

Over 60 participants including clinicians, scientists, clinical research personnel, trainees, benefactors and representatives of PCa support groups will participate in this fun and enriching event.

The team will benefit from the insight and experience that will be shared by keynote speakers: Drs. Edwin Wang, Professor Depts. of Biochemistry & Molecular Biology, Medical Genetics, and Oncology, McGill University;Roy Duncan, Dept. Microbiology & Immunology and Biochemistry and Pediatrics, Dalhousie University; Susan J. Done, Associate Professor, Departments of Laboratory Medicine and Pathobiology and Medical Biophysics, University of Toronto; and Christopher Bown, Gowlings

In addition, we will have 4 talks from senior scientists Drs. Juan Jovel (Dept Medicine, U of A), Len Luyt (Chemistry Department, U of A), Andries Zijlstra (Dept. of Pathology, Microbiology, and Immunology, Vanderbilt University), Desmond Pink (Dept Oncology, U of A) and John Lewis (Dept Oncology, U of A), and 16 short talks from trainees from different institutions in the province.

Agenda-APCaRI-2016-fall-symposium

Generously supported by the Bird Dogs and the Alberta Cancer Foundation

- Catalian Vasquez