Should men be worried if their PSA level increases even a year after receiving prostate cancer treatment with LDR Brachytherapy, or seed implant? While rising PSAs are concerning, these patients may be experiencing only a benign (non-cancerous) PSA bounce.
What is PSA Bounce?
Men typically expect a steady decrease in prostate specific antigen (PSA) blood test levels after receiving treatment for prostate cancer. While it may be particularly dismaying to men to have a PSA rise in the months after their treatment—instead of the continued PSA drop—more often than not this rise typically resolves without further treatment.
William C. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, addresses this question in Harvard Medical School’s Prostate Knowledge newsletter. “You may be experiencing nothing more than a temporary, benign rise in PSA, a phenomenon often called a PSA bounce, spike, or bump. It’s defined as an increase in PSA of 0.1 to 0.5 ng/ml—or a rise in PSA of 15% or greater over the pre-bounce level—followed by a quick drop to pre-bounce levels without treatment.”
What Causes PSA Bounce?
“Doctors aren’t sure what causes a PSA bounce, though several theories exist. Studies have shown an association between recent ejaculation and higher PSA levels, for example, as well as proctitis (inflammation of the rectum) and the insertion of a catheter. Age and radiation dose may play a role as well. There can also be variability among laboratories in determining PSA levels. Another theory is that a patient may be experiencing a late reaction to the radiation, such as radiation prostatitis,” according to Dr. DeWolf.
What is PSA?
Prostate specific antigen (PSA) is a substance produced by the prostate gland that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate. PSA is produced along with semen and helps keep it liquid.
What Happens Next?
Follow up visits after prostate cancer treatment include regular monitoring of PSA level. Physicians carefully consider men’s health in tandem with conditions thought to contribute to rising PSA.
If you have increasing PSA levels after prostate cancer treatment, such as seed implant, your doctor might recommend:
- Close monitoring. Allowing the post treatment PSA levels to resolve, while repeating PSA testing every 3, 6 or 12 months.
- Medication. If your doctor suspects prostatitis, you might be prescribed certain medications to cure the infection.
- Additional tests. If a second test shows high PSA levels, your doctor might recommend imaging of the prostate with ultrasound, CT scan or magnetic resonance imaging (MRI). Prostate cancer cells in remaining prostate tissue or in other parts of your body can release PSA. If cancer is suspected, you might need a repeat biopsy to check remaining prostate tissue.
“The challenge for clinicians is to determine whether the rising PSA represents a bounce or cancer progression. With radiation, treatment is generally not considered a failure until a patient experiences three consecutive increases in PSA,” according to Dr. DeWolf”. “Treatment failure following radiation can also be defined as an increase of 2 ng/ml over the PSA nadir (low point) at any time.” Again, most cases of PSA bounce following seed implant treatment resolve over time. Dr. Richard G. Stock reported in International Journal of Radiation Oncology that “PSA bounce does not predict for future PSA failure.”
Who Gets PSA Bounce?
Reporting in Prostate Cancer: A Comprehensive Perspective, Peter Acher concurred that “Following radiotherapy for prostate cancer, the serum PSA level will fall to reach a nadir (low point) several years later. PSA bounce refers to a benign intermittent PSA rise prior to subsequent decrease. Pre-intervention counseling and judicious timing and frequency of PSA-testing post treatment may help relieve the anxieties associated with PSA bounce.”
For more information about prostate cancer consultation, screening, treatment, or follow up, contact us at 630-654-2515, or visit prostateimplant.com. For one man’s perspective, view a YouTube video featuring Bob–a recent patient whose benign PSA rise resolved successfully–with treating physician, Dr. Brian Moran, Chicago Prostate Cancer Center’s Medical Director.
Chicago Prostate Cancer Center treats prostate cancer with a focus on quality of life.