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Prostate-specific antigen bounce following radical prostatectomy and external beam radiotherapy: A case series

International Journal of Radiology & Radiation Therapy
Christina A Anthony,1,2 Phillip Stricker,3 David Ende,3 Graham Coombes,4 Gerald B Fogarty1,5,6


Introduction: Localized prostate cancer (CaP) is often cured with radical prostatectomy (RP). To prolong PSA biochemical control, post-operative external beam radiotherapy (EBRT) can be given. PSA levels, however, can unexpectedly go through a bounce. When PSA readings don’t go according to the prediction of the treating team, patients’ expectations may not be met, and confidence can decrease. PSA bounce is not well described after RP followed by EBRT.
Methods: We present a series of six cases with no history of hormone therapy with a PSA bounce after RP followed by EBRT. Bounce was defined as any rise in PSA from previous that recovered without intervention. Analysis to find any common cause was done.
Results: Averages included patient age of 63 years; presenting PSA of 7; gland size of 44g; Gleason score of 7 and tumor volume of 3.1cc. On average they had 2 factors tha justified post-operative RT, the average nadir post RP was 0.14, 5 had salvage RT and had RT at an average of 38 months post RP. On average the bounce happened 10 months after RT, the average height of the bounce for 5 of 6 patients was 0.03ng/ml, the average duration for 5 of 6 patients was three months, 5 of 6 were stable on observation and 4 experienced second bounces at an average of 3 years after the first bounce which were all of lower amplitude than the first. No common thread in causality of the bounce was found except that the majority (5/6) had a PSA nadir that was still detectable post RP.
Conclusion: We suggest the treating team prepare patients for a possible bounce up front, especially those who do not nadir to undetectable post RP.


CaP, carcinoma of prostate, Cc, cubic centimeters, Gms, grams, ECE, extra capsular extension, IHD, ischaemic heart disease, LN+, lymph node involvement, mar+, margin positive, MeSH