Temporary PSA rises and repeat prostate biopsies after brachytherapy

Purpose: The long-standing confusion regarding the clinical relevance of po stimplant biopsies is complicated by the on occurrence of temporary PSA ris es between 1 and 2 years after brachytherapy. We report here 4 patients wit h temporary, self-limited PSA rises and postimplant biopsies, for whom radi cal prostatectomy was strongly advised but for whom surgery would probably have been the wrong choice. Materials and Methods: Transperineal I-125 or Pd-103 implants were performe d as previously described. After implantation, patents were followed routin ely, with repeat PSA and physical examination at approximately every 4 to 6 months. Timing of postimplant PSAs was at the discretion of the patient an d his doctors. Postimplant biopsies were performed in all cases out of conc ern for a persistently elevated serum PSA. Sections of fixed arid embedded tissue were stained with standard hematoxylin and eosin. Results: All patients presented here were advised to have a salvage prostat ectomy based primarily on their PSA changes. However, all of the patients h ave subsequently had a dramatic PSA fall, consistent with long-term cancer control, despite the fact that 3 of the 4 had histologic evidence of persis tent cancer on repeat prostate biopsy. Conclusions: It is crucial that clinicians be aware of the potential for th e doubly confusing situation of temporary PSA rises and apparently positive rebiopsies and the pressure it puts on both patients and their physicians to go ahead with inappropriate salvage therapy. (C) 2001 Elsevier Science I nc.