%0 Journal Article
%T Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost
%A Anurag K Singh
%A Peter Guion
%A Robert C Susil
%A Deborah E Citrin
%A Holly Ning
%A Robert W Miller
%A Karen Ullman
%A Sharon Smith
%A Nancy Crouse
%A Denise J Godette
%A Bronwyn R Stall
%A C Norman Coleman
%A Kevin Camphausen
%A Cynthia M¨Śnard
%J Radiation Oncology
%D 2006
%I BioMed Central
%R 10.1186/1748-717x-1-28
%X Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise >35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml.Median follow-up was 24 months (range 18¨C36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6.We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.There are over 200,000 new cases and nearly 30,000 deaths each year from prostate cancer [1]. External beam radiation therapy (EBRT) and/or brachytherapy are mainstays of local therapy. Low dose rate (LDR) brachytherapy, with permanently implanted radioactive seeds, [2-6] and HDR brachytherapy, with temporarily implanted catheters, has been used to treat prostate cancer [7-10].Prostate-specific antigen (PSA) is a sensitive measure of treatment outcome after radiotherapy (RT) for prostate cancer[11]. When RT is successful, the PSA level falls. If RT fails, the PSA increases over time. Independent of treatment,
%U http://www.ro-journal.com/content/1/1/28