Bounce back.

We’re always trying to improve our skilz of picking out the best and worst prostate cancers on the school yard. Circulating tumor DNA just beat out our conventional PSA gauge, but now PSA wants a rematch. Another MSKCC experience is reported this week in Red Journal. It spans over 20 years across almost 800 patients treated with definitive dose-escalated (>75Gy) external radiation without ADT. Interesting results indicate that a PSA “bounce” (i.e., a transient rise of at least 0.2 ng/ml) is associated with better metastasis-free and cancer-specific survivals. This data may be particularly useful in reassuring your next nervous Nellie with a PSA blip that he has a great chance of rebounding to durably-low PSA levels.