Toledano Alain, Chauveinc Laurent, Flam Thierry, Thiounn Nicolas, Solignac Suzette, Timbert Michel, Rosenwald Jean-Claude, Cosset Jean-Marc
Department of Oncology Radiotherapy, Institut Curie, Paris, France.
Brachytherapy. 2006 Apr-Jun;5(2):122-6. doi: 10.1016/j.brachy.2006.02.003.
To assess the frequency and features of the PSA bounce phenomenon in a series of patients treated with permanent implant brachytherapy for prostate cancer, and to evaluate the percentage of cases in which this bounce could have mimicked a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology consensus criteria.
From January 1999 to December 2001, 295 patients were treated with a permanent prostate implantation (real-time technique, with free (125)I seeds) by the Paris Institut Curie/Hospital Cochin/Hospital Necker Paris group. Duration of followup is 40.3 months (9-66 months). PSA level was reported at intervals not exceeding 6 months. Bounce was defined by temporary elevation in PSA level, followed by a spontaneous decrease.
In our series, 161 patients (55%) showed a transitory PSA increase (bounce) of at least 0.1 ng/mL; 145 patients (49%) a bounce of 0.2 ng/mL; 93 patients (32%) a bounce of 0.4 ng/mL; and 43 patients (15%) a bounce of at least 1 ng/mL. Mean PSA bounce was 0.8 ng/mL (0.1-4.1), and mean time to bounce was 19 months. Thirty-two patients (11% of total) presented three successive PSA increases, and therefore were to be considered as experiencing a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Among those 32 patients, 18 (56%) subsequently showed, without any treatment, a complete normalization of their PSA. In multivariate analysis, age <70 (p<0.0001) and D90>200Gy (p<0.003) were identified as independent factors for a PSA bounce of at least 0.4 ng/mL.
The observed rate of 32% of patients showing a PSA bounce of at least 0.4 ng/mL in our series is in good agreement with what has been previously reported in the literature. Among 32 patients fulfilling the classical ASTRO criteria for a biochemical relapse, 18 (56%) subsequently showed a spontaneous PSA decrease, questioning the ASTRO consensus for the biochemical followup of patients undergoing permanent implant prostate brachytherapy.
评估接受前列腺癌永久性植入近距离放射治疗的一系列患者中前列腺特异性抗原（PSA）反弹现象的频率和特征，并根据美国放射肿瘤学会的共识标准评估该反弹可能被误诊为生化复发的病例百分比。
1999年1月至2001年12月，巴黎居里研究所/科尚医院/巴黎内克尔医院团队对295例患者进行了永久性前列腺植入治疗（实时技术，使用游离（125）I种子）。随访时间为40.3个月（9 - 66个月）。PSA水平每隔不超过6个月报告一次。反弹定义为PSA水平暂时升高，随后自发下降。
在我们的系列研究中，161例患者（55%）出现至少0.1 ng/mL的PSA短暂升高（反弹）；145例患者（49%）反弹0.2 ng/mL；93例患者（32%）反弹0.4 ng/mL；43例患者（15%）反弹至少1 ng/mL。PSA平均反弹值为0.8 ng/mL（0.1 - 4.1），平均反弹时间为19个月。32例患者（占总数的11%）出现三次连续的PSA升高，因此根据美国放射肿瘤学会（ASTRO）的共识标准应被视为经历生化复发。在这32例患者中，18例（56%）随后在未接受任何治疗的情况下PSA完全恢复正常。多因素分析显示，年龄<70岁（p<0.0001）和D90>200Gy（p<0.003）是PSA至少反弹0.4 ng/mL的独立因素。
在我们的系列研究中观察到32%的患者出现至少0.4 ng/mL的PSA反弹，这与先前文献报道的结果一致。在符合经典ASTRO生化复发标准的32例患者中，18例（56%）随后出现PSA自发下降，这对ASTRO关于接受永久性植入前列腺近距离放射治疗患者生化随访的共识提出了质疑。
