ArticleJournal of medical case reports2025
Bounce effect or local recurrence after low-dose-rate brachytherapy of the prostate? When prostate-specific membrane antigen positron emission tomography-computed tomography is false positive: a case report.
Article in Journal of medical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionLow-dose-rate brachytherapy has been increasingly utilized as a minimally invasive treatment option in patients with low- and intermediate-risk prostate cancer. Following 1-2 years of treatment, a "bounce phenomenon" might occur in approximately 30% of patients undergoing low-dose-rate brachytherapy, characterized by a transient rise in prostate-specific antigen levels followed by a subsequent decrease. This phenomenon has been identified as a favorable prognostic factor. To date, only a few cases of a potential false-positive prostate-specific membrane antigen positron emission tomography-computed tomography related to the bounce phenomenon have been reported in literature. By presenting our clinical case, we aim to suggest refinements in the follow-up strategies and to assess the diagnostic value of prostate-specific membrane antigen positron emission tomography-computed tomography in managing cases with the bounce phenomenon. CASE PRESENTATION: A 66-year-old Caucasian (western European) male patient achieved a prostate-specific antigen nadir of 1.37 µg/l at 9 months after undergoing brachytherapy. At 21 months post-procedure, his prostate-specific antigen rose to 4.16 µg/l-following a period of stable and low prostate-specific antigen levels-prompting his general practitioner to refer him for prostate-specific membrane antigen positron emission tomography-computed tomography (298 MBq F-18-PSMA). Imaging revealed a prostate-specific membrane antigen-avid lesion within the prostate, suggesting a local recurrence, resulting in the offer of salvage therapy for the patient. However, a routine prostate-specific antigen screening before initiating salvage radiotherapy revealed a decrease to 3.75 µg/l with an additional reduction to 2.68 µg/l at 2 months later. The pattern of transient prostate-specific antigen elevation strongly suggested a bounce phenomenon rather than a recurrence, allowing any unnecessary treatment to be avoided. To date, prostate-specific antigen levels have been decreasing to as low as 0.48 µg/l, showing a satisfactory progress.
conclusionOur case illustrates a sporadically recognized false-positive prostate-specific membrane antigen positron emission tomography-computed tomography finding associated with a bounce phenomenon following low-dose-rate brachytherapy for prostate cancer. A single prostate-specific antigen test effectively ruled out the suspicion of local recurrence. While prostate-specific membrane antigen positron emission tomography-computed tomography is undoubtedly a valuable tool for detecting metastasis postoperatively, careful interpretation of local findings is essential owing to the potential for false positives. This consideration is vital when evaluating a patient with a rising prostate-specific antigen level after brachytherapy, to avoid premature initiation of salvage therapy.
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