PSA Bounce After

Radiation Failure

After radiation therapy for localized prostate cancer, a rise in PSA after it has reached its lowest level (nadir) is known as biochemical recurrence. Biochemical recurrence is associated with the development of subsequent distant metastases and death. Biochemical recurrence predates the development of distant metastasis by several years. A phenomenon specific to post radiation biochemical recurrence, is the PSA Bounce. PSA bounce or rising PSA  after radiation is associated with inflammation or other conditions other than metastatic disease. This usually occurs within 2 years after radiation therapy. It is thought to be due to conditions such as radiation-induced prostatits, cystitis, and post radiation cell breakdown.

 

Misinterpretation of PSA in such patients will lead to unnecessary treatment with salvage procedures or androgen-deprivation therapy (ADT). ADT causes significant side-effects and should not be used unless absolutely necessary.

 

It is estimated that about 75,000 newly diagnosed prostate cancer cases get radical surgery (about 30% of new diagnosis)(1)  and about 60,000 patients get radiation therapy (approx. 25% of those diagnosed)(2). Although the numbers very 22%-63% of patients following radiation will experience biochemical recurrence within 10 years (3) 

Men who have had radiation should be evaluated for local or distant metastases  based on several criteria. If after radiation the PSA decreases and then rises within 2 years they should initially be evaluated for PSA bounce. Continued rise in PSA should trigger an evaluation for recurrence, locally or for distant metastases. See also Section on 'Controversies in Definition of Local Recurrence'. 

(1) Burkhardt JH et al, J Clin Oncol. 2002; 20:2869

(2) Shipley WU et al, JAMA. 1999; 281:1598.

(3)Kupelian PA et al; Urology. 2006; 68:593.

DR NARAYAN AT    NFLUA.HIFU@GMAIL.COM

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