Prostate-specific antigen 'bounce' after permanent 125I-implant brachytherapy in Japanese men: A multi-institutional pooled analysis

Takefumi Satoh, Hiromichi Ishiyama, Kazumasa Matsumoto, Hideyasu Tsumura, Masashi Kitano, Kazushige Hayakawa, Shin Ebara, Yasutomo Nasu, Hiromi Kumon, Susumu Kanazawa, Kenta Miki, Shin Egawa, Manabu Aoki, Kazuhito Toya, Atsushi Yorozu, Hirohiko Nagata, Shiro Saito, Shiro Baba

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27 Citations (Scopus)


Objective To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level 'bounce' after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer. Patients and methods A multi-institutional pooled analysis was carried out in 388 consecutive patients with T1-T2N0M0 prostate cancer treated with 125I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had ≥1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall. RESULTS The actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after 125I-BT. Among the before and after 125I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001). CONCLUSIONS PSA bounce is a common phenomenon after 125I-BT and occurred at a rate of 19-51% in the Japanese men who underwent 125I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after 125I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.

Original languageEnglish
Pages (from-to)1064-1068
Number of pages5
JournalBJU International
Issue number8
Publication statusPublished - Apr 2009


  • Brachytherapy
  • Prostate cancer
  • Prostate-specific antigen (PSA) bounce

ASJC Scopus subject areas

  • Urology


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