PSA kinetics following primary focal cryotherapy (hemiablation) in organ-confined prostate cancer patients
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We aim to evaluate prostate-specific antigen (PSA) trends in post-primary focal cryotherapy (PFC) patients.
Materials and methods
This was an institutional review board-approved retrospective study of PFC patients from 2010 to 2015. Patients with at least one post-PFC PSA were included in the study. Biochemical recurrence (BCR) was determined using the Phoenix criteria. PSA bounce was also assessed. We analyzed rates of change of PSA over time of post-PFC between BCR and no BCR groups. PSA-derived variables were analyzed as potential predictors of BCR.
A total of 104 PFC patients were included in our analysis. Median (range) age and follow-up time were 66 (48–82) years and 19 (6.3–38.6) months, respectively. Four (3.8%) patients experienced PSA bounce. The median percent drop in first post-PFC PSA of 80.0% was not associated with BCR (p = 0.256) and may indicate elimination of the index lesion. The rate of increase of PSA in BCR patients was significantly higher compared to patients who did not recur (median PSA velocity (PSAV): 0.15 vs 0.04 ng/ml/month, p = 0.001). Similar to PSAV (HR 9.570, 95% CI 3.725–24.592, p < 0.0001), PSA nadir ≥ 2 ng/ml [HR (hazard ratio) 1.251, 95% CI 1.100–1.422, p = 0.001] was independently associated with BCR.
A significant drop in post-PFC PSA may indicate elimination of the index lesion. Patients who are likely to recur biochemically have a significantly higher PSAV compared to those who do not recur. Nadir PSA of less than 2 ng/ml may be considered the new normal PSA in focal cryotherapy (hemiablation) follow-up.
KeywordsHemiablation Focal cryotherapy Prostate-specific antigen Trends Bounce Prostate cancer Biochemical recurrence
DM Halpern was involved in data collection. S Islam was involved data analysis. AK Mbah was involved in data analysis and interpretation. GT Werneberg was involved in editing the manuscript. C Chen was involved in editing the manuscript. DJ Habibian was involved in data collection and editing the manuscript. M Kongnyuy was involved in data interpretation and manuscript writing. KE Kosinski was involved in editing the manuscript. JT Schiff was involved in editing the manuscript. AT Corcoran was involved in editing the manuscript. AE Katz was involved in manuscript editing and others (supervision).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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