Department of Urology, University of Regensburg, Regensburg, Germany. Department of Urology, Harlaching Hospital, Munich; Department of Urology, Fuerth Hospital, Fuerth, Germany; Department of Urology, Duke University, Durham, NC; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology, Stepping Hill Hospital, Stockport, UK; Department of Urology, St Anna Hospital, Como, Italy; Department of Urology, Edouard Herriot Hospital, Lyon; Department of Urology, CHU Pellegrin, Bordeaux; Department of Urology, Beausoleil Hospital, Montpellier, France.
Study Type - Prognosis (retrospective cohort) Level of Evidence 2b.
To determine if the prostate-specific antigen (PSA) nadir after high-intensity focused ultrasound (HIFU) can be used as a predictor of the biochemical disease-free survival rate (DFSR).
Patient data were derived from the multicentre-based @-Registry, the largest registry to report outcomes in patients with localized prostate cancer after Ablatherm® HIFU. PSA level was measured at 3-month intervals. Patients were stratified into four PSA nadir groups: group 1, ≤ 0.2 ng/mL; group 2, 0.21-0.5 ng/mL; group 3, 0.51-1 ng/mL; and group 4, >1 ng/mL. Biochemical treatment failure was defined according to the Stuttgart definition (PSA nadir + 1.2 ng/mL) and the Phoenix definition (PSA nadir + 2 ng/mL). Biopsy was performed at 3-6 months post-HIFU or if a PSA level was recorded that was considered clinically relevant.
The present study included 804 patients. Biochemical treatment success rates at 5 years according to the Stuttgart definition for the four PSA nadir sub-groups were as follows: 84, 64, 40 and 30% for groups 1-4, respectively. The equivalent 5-year biochemical success rates using the Phoenix definition were 94, 74, 66 and 47%, respectively. Significantly more patients had a negative biopsy in the lowest PSA nadir group than in the other sub-groups (91.6 vs 73.1%; P < 0.001). The present study is limited by its retrospective nature and variations in clinical practice across participating centres.
This multicentre analysis confirms that PSA nadir after HIFU predicts biochemical DFSR in a statistically significant manner.
Ganzer R, Robertson CN, Ward JF, Brown SC, Conti GN, Murat FJ, Pasticier G, Rebillard X, Thuroff S, Wieland WF, Blana A. Are you the author?
Reference: BJU Int. 2011 Feb 18. Epub ahead of print.