Elevated Prostate-specific Antigen Levels Research Articles

Malakoplakia of the prostate diagnosed by elevated PSA level and transrectal prostate biopsy

Malakoplakia is an inflammation which is thought to develop secondary to chronic Escherichia coli infections. Although often seen in the genitourinary tract, it can also be seen in colon, stomach, lung, liver, bone, uterus, and skin. In this case report, we present prostatic malakoplakia diagnosed by elevated prostate-specific antigen level and transrectal prostate biopsy.

Screening and Diagnosis of Prostate Cancer in Patients with Ileal Pouch–Anal Anastomosis: Consensus From an Expert Panel

Screening for prostate cancer after restorative proctocolectomy with ileal pouch-anal anastomosis can be challenging. Diagnostic biopsy for an elevated level of prostate-specific antigen may present difficulties as well. No guidelines have been issued regarding the value and accuracy of digital examination and the best route to obtain prostate biopsy specimens. A screening and diagnostic algorithm for prostate cancer was developed by an expert consensus panel.

To Screen or Not to Screen: Ongoing Debate in the Early Detection of Prostate Cancer

Debate about the use of prostate-specific antigen (PSA) tests to screen prostate cancer in men is ongoing. Prostate cancer is the most common cancer after skin cancer in men and the second most deadly after lung cancer. An elevated PSA level can lead to this cancer's diagnosis and treatment even before the onset of symptoms. However, other causes also can create a high PSA level, which may lead to men being unnecessarily treated for prostate cancer. This article will shed some light on the issue and discuss prostate cancer screening.

Diffusion MRI predicts transrectal ultrasound biopsy results in prostate cancer detection

To evaluate the ability of diffusion tensor imaging (DTI) to predict the transrectal ultrasound (TRUS) biopsy outcomes in persons who have no history of previous TRUS biopsy and present with elevated prostate-specific antigen (PSA) levels. Thirty-seven participants underwent DTI, followed by 12-core TRUS-guided needle biopsy within 2 weeks. DTI was performed using endorectal coils on a 1.5 Tesla scanner at 1-mm(3) spatial resolution. By comparing with the TRUS biopsy results, the optimum thresholds of the trace apparent diffusion coefficient (tADC) and of the nodular size were investigated. The diagnostic performance of both criteria, the tADC threshold (Criteria A) and the tADC threshold combined with nodular size threshold (Criteria B), were evaluated. The optimum tADC threshold was 1.0 μm(2)/ms. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of prostate cancer (PCA) detection for Criteria A were 98%, 89%, 73%, 99%, and 91%, respectively, and were 97%, 98%, 92%, 99% and 98% for Criteria B. Owing to high negative predictive value, the tADC threshold could be used to exclude subjects with clinically undetectable PCA. Adding the nodular size threshold, the combined threshold could identify the tADC-positive segments that are likely to yield positive biopsy results.

Prostate specific antigen and NF-kB in prostatic disease: relation with malignancy

IntroductionNF-kB (p50/p65) is a transcription factor involved in TNF-a-induced cell death resistance by promoting several antiapoptotic genes. We intend to relate the expression of NF-kB (p50 and p65) with serum levels of prostate-specific antigen (PSA), both in normal males and in those with pathologic conditions of the prostate. Materials and methodsThis study was carried out in 5 normal, 24 benign prostatic hyperplastic (BPH) and 19 patients with prostate cancer (PC). Immunohistochemical and Western blot analyses were performed on tissue and serum PSA was assayed by PSA DPC Immulite assays (Diagnostics Products Corporation, Los Angeles, CA). ResultsIn controls, p65 NF-kB was not found and p50 was scantly detected in 60% normal samples in the cytoplasm of epithelial cells. Both p50 and p65 were expressed in 62.5% of samples with BPH and in 63.2% of the samples with PC. Both increased its frequency of expression with higher PSA serum levels. ConclusionsActivation of NF-kB revealed by its nuclear translocation in prostate cancer could be related to cancer progression and elevated serum levels of PSA. A better understanding of the biologic mechanism by which circulating PSA levels increase and its relation with NF-kB expression is needed. Possibly, NF-kB blockage could be used as a therapeutic target to counteract proliferation in prostate cancer.

Antígeno prostático específico y NF-kB en patología prostática: relación con la malignidad

Introduction NF-kB (p50/p65) is a transcription factor involved in TNF-α-induced cell death resistance by promoting several antiapoptotic genes. We intend to relate the expression of NF-kB (p50 and p65) with serum levels of prostate-specific antigen (PSA), both in normal males and in those with pathologic conditions of the prostate. Materials and methods this study was carried out in 5 normal, 24 benign prostatic hyperplastic (BPH) and 19 patients with prostate cancer (PC). Immunohistochemical and Western blot analyses were performed on tissue and serum PSA was assayed by PSA DPC Immulite assays (Diagnostics Products Corporation, Los Angeles, CA). Results in controls, p65 NF-kB was not found and p50 was scantly detected in 60% normal samples in the cytoplasm of epithelial cells. Both p50 and p65 were expressed in 62.5% of the samples with BPH and in 63.2% of those with PC. Both increased its frequency of expression with higher PSA serum levels. Conclusions Activation of NF-kB revealed by its nuclear translocation in prostate cancer could be related to cancer progression and elevated seric PSA levels. A better understanding of the biologic mechanism by which circulating PSA levels increase and its relation with NF-kB expression is needed. Possibly, NF-kB blockage could be used as a therapeutic target to counteract proliferation in prostate cancer.

播種性骨髄癌腫症を呈した前立腺癌の2例

Disseminated carcinomatosis of the bone marrow is caused by metastasis to the bone marrow and can cause disseminated intravascular coagulation (DIC), leucoerythroblastosis, and microangiopathic hemolytic anemia (MHA). The prognosis of this syndrome is poor. We report herein two rare cases of disseminated carcinomatosis of the bone marrow in association with prostate cancer. Case 1 involved a 61-year-old man admitted to our department with elevated prostate-specific antigen (PSA) levels. Prostate biopsy revealed prostate cancer, and imaging studies were performed. Under a diagnosis of prostate cancer (T3N1Mx), the patient was treated using hormonotherapy, but died 2 months after admission due to gastrointestinal bleeding of unknown cause, refractory DIC, and cachexia. Bone marrow biopsy after his death revealed metastasis of the prostate cancer to the bone marrow. Case 2 involved a 68-year-old man admitted to our department with gross hematuria. Cystoscopy revealed non-papillary tumor in the prostatic urethra. Transurethral biopsy was performed and histology identified prostate cancer. Treatment was initiated with hormonotherapy and zoledronate. After 8 months, he complained of general fatigue and blood testing identified anemia and thrombocytopenia. Bone marrow biopsy revealed adenocarcinoma in the bone marrow. Alternative androgen therapy and chemotherapy with docetaxel was started, and the patient recovered from pancytopenia and general fatigue.

The potential of FDG-PET/CT for detecting prostate cancer in patients with an elevated serum PSA level

The aim of this study is to evaluate the potential and limitation of FDG-PET/CT for detecting prostate cancer in subjects with an elevated serum prostate-specific antigen (PSA) level. Although [¹⁸F]-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has limited value in detecting prostate cancer, the potential of PET/CT has not been precisely evaluated, since positron emission tomography/computed tomography (PET/CT) provides accurate localization of functional findings obtained by PET. Subjects with an increasing PSA level suggestive of prostate cancer were enrolled in this study. FDG-PET/CT was performed prior to prostate biopsy and the findings were compared with the pathological results. Fifty subjects with an elevated serum PSA level took part in this study. The sensitivity, specificity and positive predictive value (PPV) of FDG-PET/CT in the prostate were 51.9% (27/52 areas), 75.7% (112/148 areas) and 42.9% (27/63 areas), respectively; those in the peripheral zone were 73.3% (22/30 areas), 64.3% (45/70 areas) and 46.8% (22/47 areas), respectively; and those in the central gland were 22.7% (5/22 areas), 85.9% (67/78 areas) and 31.3% (5/16 areas), respectively. The estimated cut-off values according to the highest odds ratio (OR) were age of 70 years [OR: 7.00, 95% confidence interval (CI): 1.89-25.93] and a PSA value of 12.0 ng/ml (OR: 10.77, 95% CI: 2.78-41.74). The FDG-PET/CT could potentially detect cancer with 80.0% sensitivity and 87.0% PPV in cases with a Gleason score of 7 or greater. FDG-PET/CT was appropriate for detecting peripheral zone prostate cancer in patients at more than an intermediate risk.

Prostate biopsy in patients with long-term use of indwelling bladder catheter: What is the rationale?

ObjectiveAcute urinary retention (AUR) is expected to occur in 2% to 39% men with benign prostatic hyperplasia. To date, no study has elucidated the effect of long-term use of indwelling bladder catheter on serum prostate specific antigen (PSA) levels and on the incidence of prostate cancer (CaP). The aim of the present study is to analyze the incidence of CaP in patients with long-term use of indwelling bladder catheter and determine some practice patterns on this issue. Materials and methodsThe study comprised a retrospective analysis of data from 1,651 patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy from July 2004 to June 2009. Among these patients, 198 (12%) were using an indwelling bladder catheter during the biopsy for at least 1 month. The incidence of CaP was recorded according to total PSA levels. Other variables such patient age, free/total PSA rate, PSA density, prostate volume, and duration of catheter use was also analyzed. Men with a digital rectal examination suspicious for cancer were not considered for analysis. ResultsMedian patient age was 71 years (37 to 89 years). Overall, 25% of patients presented a CaP diagnosis. CaP incidence according to the PSA levels was 0%, 18.9%, 24.5%, and 40.6% for patients with PSA ≤4.0, 4.1–10.0, 10.1–20.0, and >20.0 ng/ml, respectively. When prostate volume was analyzed together, we demonstrated that only 1 (2.4%) patient with PSA below 10.0 ng/ml and prostate volume >60 g had CaP. Median total PSA, PSA density, and prostate volume were statistically different between patients with and without CaP. ConclusionsProstate biopsy should not be indicated for all patients with diagnosis of BPH and AUR who present an elevated PSA level. Patients with PSA below 10.0 ng/ml, and prostate volume >60 g should only undergo biopsy in selected cases. Patients with PSA >20.0 ng/ml and a prostate volume ≤60 g are at higher risk of CaP diagnosis.

Association of Insurance and Race/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006

Previous studies documenting variations in severity of prostate cancer at diagnosis by race/ethnicity and insurance status have been limited to small sample sizes and patients ≥65 years of age. This study examines disease severity among patients ages 18 to 99 from the National Cancer Database (NCDB). Patients diagnosed between 2004 and 2006 with prostate cancer were selected from the NCDB (n = 312,339). We evaluated the association among three disease severity measures: prostate specific antigen (PSA) level, Gleason score 8 to 10, and clinical T-stage 3/4, by race/ethnicity and insurance while adjusting for sociodemographic and clinical factors. Uninsured and Medicaid-insured patients had elevated PSA levels, higher odds of advanced Gleason score [uninsured odds ratio (OR), 1.97; 95% confidence interval (95% CI), 1.82-2.12; Medicaid OR, 1.67; 95% CI, 1.55-1.79], and advanced clinical T stage (uninsured OR, 1.85; 95% CI, 1.69-2.03; Medicaid OR, 1.49; 95% CI, 1.35-1.63) compared with privately insured patients. Black (OR, 1.19; 95% CI, 1.15-1.23), Hispanic (OR, 1.16; 95% CI, 1.10-1.23), and Asian patients (OR, 1.22; 95% CI, 1.24-1.43) had higher odds of advanced Gleason score and similar odds of advanced stage of disease relative to whites. Insurance status is strongly associated with disease severity among prostate cancer patients. Strong associations between insurance and disease severity may be related to lack of access to preventive services such as PSA screening and barriers to medical evaluation. Although the risks and benefits of PSA screening have not been fully elucidated, it is important that all men have the opportunity to be informed about this option and preventative medical services.

043 Adjusting misclassification of outcome in case-control studies

ObjectiveMisclassification of outcome may cause biased estimation for associations of potential risk factors with important diseases. For example, case-control studies of localised prostate cancer frequently measure blood levels of circulating...

Prostate cancer imaging: what the next decade holds

Prostate carcinoma is the most commonly diagnosed malignancy and the second most common cause of male cancer death in the USA [1]. Autopsy and early observational studies have shown that approximately one out of three men above the age of 50 years has histologic evidence of prostate carcinoma. While a portion of these tumors may be very aggressive and lethal, others are possibly clinically insignificant [2]. Identifying the lethal form of this tumor remains a challenge in this heterogeneous malignancy. The clinical presentation of prostate cancer may range from an asymptomatic condition to a rapidly progressive systemic illness. Prostate specific antigen (PSA) screening has resulted in earlier detection and a downstaging of prostate cancer at diagnosis. At the same time, the commonly used PSA cutoff of 2.5 ng/ml, used by urologists for biopsy, also leads to a significant number of unnecessary biopsies, leading to over diagnosis and overtreatment of indolent disease [3]. Thus far, imaging has only played a relatively small role in the management of localized prostate cancer. The current standard imaging techniques, such as transrectal ultrasound (TRUS), MRI, computed tomography (CT) and nuclear medicine studies, are not able to detect early disease, and only provide limited information for tumor, node, metastasis staging [4]. However, the role of imaging in patients with prostate cancer is evolving. New techniques are under investigation, either alone or combined with standard imaging techniques. TRUS is usually used to guide biopsies and to place brachytherapy seeds, but it does not reliably differentiate healthy from malignant prostate gland tissue. Contrast-enhanced color Doppler imaging, intermittent harmonic imaging and contrast-enhanced flash-replenishment imaging are now combined with standard TRUS. Contrast-enhanced ultrasound takes advantage of an increased density of micro vasculature in cancerous tissue compared with benign prostate tissue. Using micro bubble contrast agents, which diffuse into microvessels, this technique selectively enhances areas with increased vascularity. However, because of the relatively large size of microbubbles (~5–10 μm), leakage into the tumor cannot be well visualized and enhancement can also be due to benign conditions, such as prostatitis [5]. In a recent study of 114 patients with elevated PSA levels and previous negative biopsy contrast-enhanced advanced dynamic flow, Tina Islam

A Case of Prostatic Adenocarcinoma With Aberrant p63 Expression: Presentation With Detailed Immunohistochemical Study and FISH Analysis

Prostate carcinomas showing aberrant diffuse-nuclear p63 expression are extremely rare, and there is only 1 article in the literature reporting a series of 21 such cases. We document an additional case of p63-positive prostatic adenocarcinoma in a 60-year-old man, whose diagnosis was difficult. The patient was found to have an elevated prostate-specific antigen (PSA) level at a general health check-up and was referred to the hospital. His serum PSA was 4.2 ng/mL. Digital rectal examination and transrectal ultrasonography did not reveal a lesion. Transrectal needle biopsy of the prostate detected atypical, small prostatic glands suspected for adenocarcinoma at 2 cores. However immunohistochemistry showed nuclear p63 expression in the suspicious glands. Repeat biopsy revealed only high-grade prostatic intraepithelial neoplasia. In the third transrectal biopsy, finding of the same atypical glands showing perineural invasion facilitated the diagnosis of malignancy. The patient underwent a radical prostatectomy. Five different small tumor foci were seen in the prostate after pathological evaluation, one of which was p63 positive and the others p63 negative. The largest of the classic p63-negative tumors showed a TMPRSS2-ERG translocation by fluorescent in situ hybridization while the p63-positive tumor did not. The authors submit that this subtype (p63-positive prostate adenocarcinoma) should be listed among the recognized rare variants of prostatic adenocarcinoma.

Diet, supplement use, and prostate cancer risk: results from the prostate cancer prevention trial.

The authors examined nutritional risk factors for prostate cancer among 9,559 participants in the Prostate Cancer Prevention Trial (United States and Canada, 1994-2003). The presence or absence of cancer was determined by prostate biopsy, which was recommended during the trial because of an elevated prostate-specific antigen level or an abnormal digital rectal examination and was offered to all men at the trial's end. Nutrient intake was assessed using a food frequency questionnaire and a structured supplement-use questionnaire. Cancer was detected in 1,703 men; 127 cancers were high-grade (Gleason score 8-10). There were no associations of any nutrient or supplement with prostate cancer risk overall. Risk of high-grade cancer was associated with high intake of polyunsaturated fats (quartile 4 vs. quartile 1: odds ratio = 2.41, 95% confidence interval (CI): 1.33, 4.38). Dietary calcium was positively associated with low-grade cancer but inversely associated with high-grade cancer (for quartile 4 vs. quartile 1, odds ratios were 1.27 (95% CI: 1.02, 1.57) and 0.43 (95% CI: 0.21, 0.89), respectively). Neither dietary nor supplemental intakes of nutrients often suggested for prostate cancer prevention, including lycopene, long-chain n-3 fatty acids, vitamin D, vitamin E, and selenium, were significantly associated with cancer risk. High intake of n-6 fatty acids, through their effects on inflammation and oxidative stress, may increase prostate cancer risk.

A four-kallikrein panel for the prediction of repeat prostate biopsy: data from the European Randomized Study of Prostate Cancer Screening in Rotterdam, Netherlands

Background:Most men with elevated levels of prostate-specific antigen (PSA) do not have prostate cancer, leading to a large number of unnecessary biopsies. A statistical model based on a panel of four kallikreins has been shown to predict the outcome of a first prostate biopsy. In this study, we apply the model to an independent data set of men with previous negative biopsy but persistently elevated PSA.Methods:The study cohort consisted of 925 men with a previous negative prostate biopsy and elevated PSA (⩾3 ng ml−1), with 110 prostate cancers detected (12%). A previously published statistical model was applied, with recalibration to reflect the lower positive biopsy rates on rebiopsy.Results:The full-kallikrein panel had higher discriminative accuracy than PSA and DRE alone, with area under the curve (AUC) improving from 0.58 (95% confidence interval (CI): 0.52, 0.64) to 0.68 (95% CI: 0.62, 0.74), P<0.001, and high-grade cancer (Gleason ⩾7) at biopsy with AUC improving from 0.76 (95% CI: 0.64, 0.89) to 0.87 (95% CI: 0.81, 0.94), P=0.003). Application of the panel to 1000 men with persistently elevated PSA after initial negative biopsy, at a 15% risk threshold would reduce the number of biopsies by 712; would miss (or delay) the diagnosis of 53 cancers, of which only 3 would be Gleason 7 and the rest Gleason 6 or less.Conclusions:Our data constitute an external validation of a previously published model. The four-kallikrein panel predicts the result of repeat prostate biopsy in men with elevated PSA while dramatically decreasing unnecessary biopsies.

External Validation of Urinary PCA3-Based Nomograms to Individually Predict Prostate Biopsy Outcome

BackgroundPrior to safely adopting risk stratification tools, their performance must be tested in an external patient cohort. ObjectiveTo assess accuracy and generalizability of previously reported, internally validated, prebiopsy prostate cancer antigen 3 (PCA3) gene-based nomograms when applied to a large, external, European cohort of men at risk of prostate cancer (PCa). Design, setting, and participantsBiopsy data, including urinary PCA3 score, were available for 621 men at risk of PCa who were participating in a European multi-institutional study. InterventionAll patients underwent a ≥10-core prostate biopsy. Biopsy indication was based on suspicious digital rectal examination, persistently elevated prostate-specific antigen level (2.5–10 ng/ml) and/or suspicious histology (atypical small acinar proliferation of the prostate, >/= two cores affected by high-grade prostatic intraepithelial neoplasia in first set of biopsies). MeasurementsPCA3 scores were assessed using the Progensa assay (Gen-Probe Inc, San Diego, CA, USA). According to the previously reported nomograms, different PCA3 score codings were used. The probability of a positive biopsy was calculated using previously published logistic regression coefficients. Predicted outcomes were compared to the actual biopsy results. Accuracy was calculated using the area under the curve as a measure of discrimination; calibration was explored graphically. Results and limitationsBiopsy-confirmed PCa was detected in 255 (41.1%) men. Median PCA3 score of biopsy-negative versus biopsy-positive men was 20 versus 48 in the total cohort, 17 versus 47 at initial biopsy, and 37 versus 53 at repeat biopsy (all p≤0.002). External validation of all four previously reported PCA3-based nomograms demonstrated equally high accuracy (0.73–0.75) and excellent calibration. The main limitations of the study reside in its early detection setting, referral scenario, and participation of only tertiary-care centers. ConclusionsIn accordance with the original publication, previously developed PCA3-based nomograms achieved high accuracy and sufficient calibration. These novel nomograms represent robust tools and are thus generalizable to European men at risk of harboring PCa. Consequently, in presence of a PCA3 score, these nomograms may be safely used to assist clinicians when prostate biopsy is contemplated.

Resistive Index as Risk Factor for Acute Urinary Retention in Patients With Benign Prostatic Hyperplasia

To examine the usefulness of several parameters obtained by transrectal ultrasonography in predicting acute urinary retention (AUR). The present study consecutively enrolled 1962 men with a complaint of lower urinary tract symptoms. Of these men, 245 were found to have AUR on examination at our clinic. We assessed the International Prostate Symptom Score (IPSS), maximal urinary flow rate, and postvoid residual urine volume and measured the total prostate volume, transition zone index (TZI), and resistive index (RI) using transrectal ultrasonography. To compare the usefulness of these indexes for predicting AUR, we calculated the area under the receiver operating characteristic curve for each index and for age. In patients without AUR, age, prostate-specific antigen level, IPSS, maximal urinary flow rate, and postvoid residual urine volume were significantly correlated with both the TZI and the RI (P < .001). Multiple regression analysis demonstrated that age, maximal urinary flow rate, postvoid residual urine volume, and TZI were significant independent determinants of the RI (P < .001). Patients with AUR were, on average, older and had an elevated prostate-specific antigen level, increased IPSS, and greater TZI and RI than patients without AUR (P < .001). The area under the receiver operating characteristic curve was 0.640 (95% confidence interval [CI] 0.618-0.662) for age, 0.674 (95% CI 0.653-0.695) for prostate-specific antigen level, 0.787 (95% CI 0.768-0.805) for total prostate volume, 0.821 (95% CI 0.803-0.838) for IPSS, 0.860 (95% CI 0.844-0.875) for TZI, and 0.867 (95% CI 0.851-0.882) for RI. The RI and TZI obtained using transrectal ultrasonography correlated with the incidence of AUR and are useful predictors of AUR in patients with benign prostatic hyperplasia.

The Significance of Plasma C-reactive Protein in Patients With Elevated Serum Prostate-specific Antigen Levels

Prostatic infection/inflammation may increase serum prostate-specific antigen (PSA) levels. We hypothesized that prostatic infection/inflammation can be identified by elevated plasma C-reactive protein (CRP) levels. Measuring plasma CRP levels may help to differentiate benign conditions from prostate cancer in patients with elevated serum PSA levels. A total of 139 patients with serum PSA levels greater than 4.0 ng/mL received transrectal ultrasound guided biopsy. All of the patients had plasma high-sensitivity CRP levels measured. CRP levels higher than 0.5 mg/dL were considered abnormal. CRP and PSA levels, and prostate size were compared between benign and malignant groups. The association of CRP levels with cancer stages was also analyzed. Thirty-four out of 139 (24.5%) patients were found to have prostate cancer. There was no significant difference in CRP levels between the malignant and benign groups. Five out of 34 (14.7%) patients with prostate cancer and 13 of 105 (12.4%) patients with benign lesions had elevated CRP levels. The incidence of abnormal CRP levels was not significantly different between the groups ( p = 0.77). Patients with high PSA and CRP levels did not have a higher probability of a benign condition. It is interesting to note that in the malignant group, there was a significant positive correlation between CRP and PSA levels ( r = 0.44, p = 0.01). No significant correlation between CRP levels and cancer stages was noted. Measuring plasma CRP levels does not assist in the identification of benign conditions in patients with elevated PSA levels. However, plasma CRP levels are well-correlated with serum PSA levels in prostate cancer patients, suggesting a potential correlation between prostate inflammation and prostate cancer.

Antibiotics to “Treat” Patients with Mildly Elevated Prostate-Specific Antigen Levels?

Some clinicians prescribe antibiotics for patients with mildly elevated prostate-specific antigen (PSA) levels. The rationale is that asymptomatic

Prostate-Specific Antigen Bounce After Permanent Iodine-125 Prostate Brachytherapy—An Australian Analysis

To report on prostate-specific antigen (PSA) "bounces" after (125)I prostate brachytherapy to review the relationship to biochemical control and correlate both clinical and dosimetric variables. We analyzed 194 hormone-naive patients with a follow-up of ≥ 3 years. Four bounce definitions were applied: an increase of ≥ 0.2 ng/mL (definition I), ≥ 0.4 ng/mL (definition II), ≥ 15% (definition III), and ≥ 35% (definition IV) of a previous value with spontaneous return to the prebounce level or lower. Using definition I, II, III, and IV, a bounce was detected in 50%, 34%, 11%, and 9% of patients, respectively. The median time to onset was 14-16 months, the duration was 12-21.5 months, and the magnitude of the increase was 0.5-2 ng/mL. A magnitude of >2 ng/mL, fulfilling the criteria for biochemical failure (BF) according to the American Society for Therapeutic Radiology and Oncology Phoenix definition, was detected in 11.3%, 16.9%, 47.6%, and 50% using definitions I, II, III, and IV, respectively; 11 patients (5.7%) had true BF. The PSA bounces occurred earlier than BF (p < 0.001). The prediction of BF remains controversial and is probably unrelated to biochemical control. The only statistically significant factor predictive of a PSA bounce was younger age (definitions I and II). PSA bounces are common after brachytherapy. All definitions resulted in a high number of false-positive calls for BF during the first 2 years. The definition of an increase of ≥ 0.2 ng/mL should be preferred because of the lowest number of false-positive results for BF. Patients experiencing a PSA bounce during the first 2 years after brachytherapy should undergo surveillance every 3-6 months. Additional investigations are recommended for elevated postimplant PSA levels that have not corrected by 3 years of follow-up.