Biochemical and clinical significance of the posttreatment prostate‐specific antigen bounce for prostate cancer patients treated with external beam radiation therapy alone

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Abstract
BACKGROUND.: The posttreatment prostate‐specific antigen (PSA) bounce phenomenon has been recognized in at least 20% of all patients treated with radiation. The purpose of the current report was to determine if there was a difference in biochemical and clinical control between the bounce and nonbounce (NB) patients using pooled data on 4839 patients with T1‐2 prostate cancer treated with external beam radiation therapy (RT) alone at 9 institutions between 1986 and 1995.METHODS.: The median follow‐up was 6.3 years. A posttreatment PSA bounce was defined by a minimal rise of 0.4 ng/mL over a 6‐month follow‐up period, followed by a drop in PSA level of any magnitude. Endpoints included no biochemical evidence of disease (bNED) failure (BF) (ASTRO definition), distant failure (DF), cause‐specific failure (CSF), and overall survival (OS). Patients were stratified by pretreatment PSA, Gleason score, T stage, age, dose, and risk group.RESULTS.: In all, 978 (20%) patients experienced at least 1 posttreatment PSA bounce. Within 3 subgroups (risk group, pretreatment PSA, and age), statistically significant differences of remaining bounce‐free were observed on univariate analysis. Patients < 70 years had a 72% chance of remaining bounce‐free at 5 years compared with 75% for older patients (P = .04). The NB patients had 72% bNED control at 10 years compared with 58% for the bounce patients. The effect of a bounce remained statistically significant on multivariate analysis (P < .0001). No statistically significant difference in DF, CSF, or OS was observed.CONCLUSIONS.: Patients treated with external beam radiation therapy alone who experience a posttreatment PSA bounce have increased risk of BF. However, this did not translate into a difference in clinical failure with the available follow‐up in the current study. Cancer 2006. © 2006 American Cancer Society.

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