The phenomenon of PSA bounce after radiation therapy

Abstract

Following radiotherapy for prostate cancer, the serum PSA level will fall to reach a nadir several years later. PSA bounce refers to a benign intermittent PSA rise prior to subsequent decrease. It has been observed in all forms of primary radiotherapy strategies, most recently in stereotactic radiation where it was noted in 29 % of patients. Comparison of published data is difficult due to variations in definitions, populations studied, and types of treatment. The majority of studies, however, do not reveal a relationship between PSA bounce and biochemical control. The only consistent pretreatment factor that appears to predict for PSA bounce is patient age at treatment. The updated ASTRO definition of biochemical failure following radiotherapy treatment (PSA nadir plus 2 ng/mL) aims to reduce the false-positive rate due to bounce but is not foolproof as bounces will still occur above this value. Pre-intervention counseling and judicious timing and frequency of PSA-testing posttreatment may help relieve the anxieties associated with PSA bounce.