BACKGROUND & OBJECTIVES - Salvage prostate cryoablation is an effective treatment for patients with localized prostate cancer relapse following primary radiotherapy. The post-salvage PSA nadir that best predicts long-term biochemical progression-free survival (bPFS) is not yet defined.
FREE DAILY AND WEEKLY NEWSLETTERS OFFERED BY CONTENT OF INTEREST
Did you find this article relevant? Subscribe to UroToday-GUOncToday!
The fields of GU Oncology and Urology are advancing rapidly including new treatments, enrolling clinical trials, screening and surveillance recommendations along with updated guidelines. Join us as one of our subscribers who rely on UroToday as their must-read source for the latest news and data on drugs. Sign up today for blogs, video conversations, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.
We sought to determine what nadir PSA best predicted success following salvage whole-gland cryoablation.
METHODS - We retrospectively reviewed a cohort of 486 hormone naive patients who underwent salvage whole-gland cryoablation from the Cryo On-Line Database (COLD). Studied variables were age, race, initial PSA, pre-salvage PSA (psPSA), initial Gleason score, Gleason score at pre-salvage biopsy, clinical stage and follow up PSA values. Kaplan-Meier (KM) analysis was used to calculate five-year bPFS using the Phoenix criteria. Hazard ratio (HR) and relative risk (RR) were also analyzed. Differences among the KM estimates, at five-years, were calculated using the log-rank test.
RESULTS - Using group thresholds, KM analysis identified nadir PSA< or > 0.4 ng/ml as the nadir PSA threshold with the greatest difference in bPFS. The KM estimated five-year bPFS was 75.5% and 22.1% for nadir PSA <0.4ng/ml and nadir PSA ≥0.4 ng/ml, respectively. Stratified by psPSA, the KM estimated five-year bPFS comparing patients with PSA nadir 10ng/ml, respectively.
CONCLUSIONS - The best objective indicator of biochemical success following whole-gland salvage cryoablation of the prostate is PSA nadir < 0.4 ng/ml.
Journal of endourology / Endourological Society. 2016 Feb 26 [Epub ahead of print]
Evan Kovac, Ahmad Elshafei, Kae Jack Tay, Melissa Heuer Mendez, Thomas Polascik, J Stephen Jones
The Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, Ohio, United States ; The Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, Ohio, United States., Duke University Medical Center, Urology, Durham, North Carolina, United States ; Duke University Medical Center, Urology, Durham, North Carolina, United States ; Duke University Medical Center, Urology, Durham, North Carolina, United States ; The Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, Ohio, United States ;