Review Articleiju_3120 142..149
Interpreting a rising prostate-specific antigen after
brachytherapy for prostate cancer
Miren Gaztañaga and Juanita Crook
Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, Kelowna, British Columbia,
Abbreviations & Acronyms
ADT = androgen
bNED = biochemical “no
evidence of disease”
CSS = cause-specific
EBRT = external beam
HDR = high dose rate
LDR = low dose rate
NS = not significant
OS = overall survival
PSA = prostate-specific
TZI = transition zone index
V150 = percentage of
prostate volume receiving a
minimum of 150% of the
Correspondence: Juanita Crook
M.D., F.R.C.P.C., British
Columbia Cancer Agency,
Center for the Southern Interior,
399 Royal Avenue, Kelowna,
BC V1Y5L3, Canada. Email:
Received 19 March 2012;
accepted 17 July 2012.
Online publication 20 August
on the topic of prostate-specific antigen bounce after brachytherapy and present a
summary of the current knowledge. Although ultimately prostate-specific antigen is a
first 3 years because of the frequency with which temporary benign rises in prostate-
specific antigen occur. We have reviewed the English language literature on the topic of
prostate-specific antigen bounce under the following headings: prostate neoplasms,
brachytherapy, biochemical definition of prostate-specific antigen failure, “benign
prostate-specific antigen bounce” and “prostate-specific antigen spike”. We included
brachytherapy delivered as either low dose rate or high dose rate, and either as mono-
therapy or as a boost combined with external beam radiotherapy. A benign self-limited
of patients, but increases in frequency with younger age. In patients aged less than
volume and the use of high dose rate versus low dose rate have been implicated in
affecting the frequency of the benign bounce. Benign increases in prostate-specific
antigen are frequent after prostate brachytherapy. It is important to recognize and
correctly diagnose this phenomenon in order to avoid unnecessary salvage treatment.
The aim of the present study was to review the English language literature
biochemical definition of prostate-specific antigen failure, brachytherapy, prostate
benign prostate-specific antigen bounce, prostate-specific antigen spike,
Once a prostate cancer patient has been diagnosed and treated, management of the
follow-up period can be challenging. PSA kinetics can be very variable after non-surgical
treatment. The value of the nadir, the time to reach the nadir and fluctuations in the PSA en
route can all be open to different interpretations. The present review addresses these issues
and provides an update on the current evidence.
We reviewed the English language literature on the topic of PSA bounce under the following
headings: prostate neoplasms, brachytherapy, biochemical definition of PSA failure,
“benign PSA bounce” and “PSA spike”.
PSA nadir and the definition of biochemical failure
PSA nadir is defined as the lowest PSA in the follow-up period after radiotherapy. As the
PSA might continue to decline for several years after treatment, three consecutive stable
readings1are required to determine the nadir. Because of assay variability and the very low
levels that are achieved, especially after brachytherapy, a reading ?0.1 ng/mL can be
considered as the nadir.
International Journal of Urology (2013) 20, 142–147 doi: 10.1111/j.1442-2042.2012.03120.x
© 2012 The Japanese Urological Association
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Rising PSA after brachytherapy
© 2012 The Japanese Urological Association