Case – Prostate-specific antigen bounce: A pitfall in prostate-specific membrane antigen positron emission tomography/computed tomography interpretation
Keywords:PSA Bounce, PMSA/PET scan, PSMA, brachytherapy, radiation, prostate cancer
Prostate-specific antigen (PSA) “bounce,” a transient rise in PSA post-therapy, can happen after either brachytherapy (BT) or external beam radiation therapy (EBRT); however, it is more common in the former case. In general, PSA bounce tends to occur within 2–3 years of treatment, rarely exceeds levels of 2–3 ng/ml above the nadir PSA, and tends to resolve over 6–12 months. Studies have shown that prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) has a high sensitivity and specificity for the detection of prostate cancer recurrence and can potentially guide therapy. Because salvage treatment (such as local or systemic salvage) may have associated morbidity, it is important to exclude the possibility of PSA bounce before proceeding with salvage treatment. We describe a case of clinically suspected local failure with initial PSA rise and suspicious PSMA PET/CT finding post-therapy that was actually related to a PSA bounce, emphasizing the need for caution in the evaluation of men where a PSA bounce may be a confounding phenomenon.
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