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Abstract
A 63-year-old man with a T1c adenocarcinoma of the prostate, Gleason score of 7 (4
+ 3), and a pretreatment prostate-specific antigen (PSA) level of 9.5 ng/mL was treated
with external-beam radiation therapy (45 Gy) and 2 magnetic resonance imaging–guided
high-dose rate brachytherapy boosts (10 Gy each.) The patient also received neoadjuvant,
concurrent, and adjuvant hormonal treatment with leuprolide for 7 months total. Without
any further intervention the patient had 2 separate and prolonged PSA increases and
decreases 12-35 months after therapy. His PSA nadir was < 0.2 ng/mL and rose slowly
over several months to 4.2 ng/mL, resolved, and then rose 2.3 ng/mL before again slowly
resolving. After prostate irradiation, many patients experience a transient rise in
serum PSA levels and a subsequent decline without any treatment. This is known as
a PSA “bounce” or “bump.” Some patients experience a second transient rise in PSA
levels after irradiation. To our knowledge, this case report is the first documentation
of a second PSA bump in a patient treated with external-beam radiation therapy and
high-dose rate boost therapy and provides context to address concerns and therapeutic
decisions confronting physicians and patients.
Key words
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Article Info
Publication History
Accepted:
September 10,
2007
Received in revised form:
September 7,
2007
Received:
May 7,
2007
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Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
