This definition was criticized as the occurrence of BF was back-dated. The American Society for Therapeutic Radiology and Oncology (ASTRO) coined a definition according to which three consecutive increases of PSA after a nadir can be interpreted as a biochemical failure. Several definitions have been established to distinguish a temporary rise in PSA from biochemical failure (BF). Especially a rise in PSA upsets patients and their physicians and can lead to an unnecessary secondary therapy. PSA kinetics after radiotherapy, however, are sometimes difficult to interpret. Prostate-specific antigen (PSA) is important for early detection and follow-up of prostate cancer. PSA doubling time is an important predictor for overall survival following the diagnosis of a recurrence. Rising PSA levels within the first two years can usually be classified as a benign PSA bounce, with favourable recurrence-free and overall survival rates. 36% with PSA doubling time ˃ 5 months vs. PSA doubling time was prognostically significant in case of PSA recurrence (OS10 of 72% vs. 32 months after RT p < 0.01 median PSA doubling time 5.5 vs. A bounce was detected significantly earlier than a PSA recurrence (median 20 months vs. EBRT) proved to be independent factors for PSA recurrence in multivariate Cox regression analysis. ![]() The occurrence of a bounce, a high nadir and the therapy modality (LDR-BT vs. A PSA bounce showed to be a significant factor for biochemical control (BC) and overall survival (OS) after ten years (BC10 of 83% with bounce vs. Median follow-up after the end of radiotherapy was 108 months. “PSA bounce” was defined as an increase of at least 0.2 ng/ml followed by spontaneous return to pre-bounce level or lower, biochemical failure was defined according to the Phoenix definition. Two hundred ninety-five patients with localized prostate cancer were either treated with low-dose-rate (LDR) brachytherapy with I-125 seeds as monotherapy ( n = 94 145Gy), high-dose-rate (HDR) brachytherapy with Ir-192 as a boost to external beam RT ( n = 66 50.4Gy in 1.8Gy fractions EBRT + 18Gy in 9Gy fractions HDR) or EBRT alone (70.2Gy in 1.8Gy fractions n = 135). The aim of this study was to evaluate the long-term prognostic significance of rising PSA levels, particularly focussing on overall survival.
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