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.

Engeler DS et al.: PSA bounce after 125 brachytherapy for prostate cancer as a favorable prognosticator. Strahlenther Onkol. 2015 Oct;191(10):787-791. Epub 2015 Jun 23.

Caloglu M 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. 2010 Jun 18.

Critz FA et al.: Prostate specific antigen bounce after radioactive seed implantation followed by external beam radiation for prostate cancer, USA.J Urol 2000 Apr;163(4):1085-9

Hinnen KA et al.: Prostate Specific Antigen Bounce Is Related to Overall Survival in Prostate Brachytherapy.. Int J Radiat Oncol Biol Phys. 2011 Feb 5.

Thompson A 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 Oct 1;78(2):415-21. Epub 2010 Feb 3.

Zwahlen DR et al.: Prostate-specific antigen bounce after permanent iodine-125 prostate brachytherapy--an Australian analysis. Int J Radiat Oncol Biol Phys. 2011 Jan 1;79(1):179-87. Epub 2010 Apr 6.

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