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Related Experiment Videos

Prostate-specific antigen spikes after permanent prostate brachytherapy.

Gregory S Merrick1, Wayne M Butler, Kent E Wallner

  • 1Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV 26003-6300, USA. schifonc@wheelinghosp.com

International Journal of Radiation Oncology, Biology, Physics
|September 24, 2002
PubMed
Summary

Younger patients and those with higher first post-implant prostate-specific antigen (PSA) levels after brachytherapy are more likely to experience a PSA spike. This temporary rise in PSA does not impact long-term outcomes, as PSA levels converge over time.

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Area of Science:

  • Urology
  • Radiation Oncology
  • Medical Physics

Background:

  • Permanent prostate brachytherapy is a common treatment for prostate cancer.
  • Prostate-specific antigen (PSA) spikes can occur after brachytherapy, causing patient concern.
  • Understanding factors predicting PSA spikes is crucial for patient management and counseling.

Purpose of the Study:

  • To identify clinical, treatment, and dosimetric parameters associated with PSA spikes post-brachytherapy.
  • To evaluate the long-term impact of PSA spikes on biochemical outcomes.

Main Methods:

  • Retrospective analysis of 218 hormone-naive patients treated with permanent prostate brachytherapy.
  • Evaluation of clinical (age, stage, Gleason score), treatment (isotope, external beam radiotherapy), and dosimetric (D(90), V(100), V(150), V(200)) parameters.

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  • Definition of PSA spike as a rise of ≥0.2 ng/mL followed by a decline; median follow-up of 46.2 months.

    • Main Results:

    • 23.9% of patients developed a PSA spike at a median of 16.3 months post-treatment.
    • Younger patients (mean age 63.9 vs. 67.3 years) and those receiving 125I were more likely to spike.
    • Higher first post-implant PSA levels and specific dosimetric parameters (V(150) <55%) predicted spikes; PSA levels converged by 66 months.

    Conclusions:

    • Patient age, clinical stage, first post-implant PSA, and V(150) are predictive of PSA spikes.
    • A PSA spike is a transient phenomenon, with PSA levels normalizing in most patients over time.
    • These findings aid in counseling patients regarding expected PSA behavior after brachytherapy.