Approximately 35 percent of all patients with prostate carcinoma treated with brachytherapy experience a renewed increase in PSA following primary prostate-specific antigen (PSA) decay, which in turn spontaneously decreases after some time. Such a temporary increase in PSA usually occurs 1 to 1? years after brachytherapy and recovers after an average of 18 to 20 months. The reason for such a PSA bounce usually is an inflammation of the remaining prostate tissue (prostatitis) induced by irradiation, which, however, is not in need of treatment.
An increase in PSA after brachytherapy therefore in most cases does not indicate renewed tumor growth in the prostate (local recurrence) and is not due to a poor result of brachytherapy. Numerous studies have even shown that patients with a PSA bounce developed a PSA relapse even more rarely than patients without a PSA bounce and thus showed a very good disease prognosis. A current study from Switzerland from 2015 shows that the risk of suffering a biochemical recurrence in patients with PSA bounce is reduced by more than 75 percent.
Stay calm with PSA increase after radiation
There is no cause for concern if the PSA level rises again after brachytherapy. It is important to keep an eye on the overall situation and not to initiate premature treatment. In such situations, it makes sense to check the PSA value at three- to six-monthly intervals in accordance with the ASTRO criteria. The misdiagnosis of a PSA relapse and its unnecessary therapy as well as the patient's concern about a relapse can be avoided if the physician and patient are informed about the characteristic features of a PSA bounce.
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