World Journal of Urology

, Volume 36, Issue 2, pp 209–213 | Cite as

PSA kinetics following primary focal cryotherapy (hemiablation) in organ-confined prostate cancer patients

  • Michael KongnyuyEmail author
  • Shahidul Islam
  • Alfred K. Mbah
  • Daniel M. Halpern
  • Glenn T. Werneburg
  • Kaitlin E. Kosinski
  • Connie Chen
  • David J. Habibian
  • Jeffrey T. Schiff
  • Anthony T. Corcoran
  • Aaron E. Katz
Original Article



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.


Hemiablation Focal cryotherapy Prostate-specific antigen Trends Bounce Prostate cancer Biochemical recurrence 


Author contributions

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Croswell JM, Kramer BS, Crawford ED (2011) Screening for prostate cancer with PSA testing: current status and future directions. Oncology (Williston Park, NY) 25(6):452–460, 463Google Scholar
  2. 2.
    Force UPST (2012) Final recommendation statement: prostate cancer: screening. Accessed Mar 2017
  3. 3.
    Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level < or = 4.0 ng per milliliter. N Engl J Med 350(22):2239–2246. CrossRefPubMedGoogle Scholar
  4. 4.
    Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, Petros JA, Andriole GL (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324(17):1156–1161. CrossRefPubMedGoogle Scholar
  5. 5.
    Toussi A, Stewart-Merrill SB, Boorjian SA, Psutka SP, Thompson RH, Frank I, Tollefson MK, Gettman MT, Carlson RE, Rangel LJ, Karnes RJ (2016) Standardizing the definition of biochemical recurrence after radical prostatectomy—what prostate specific antigen cut point best predicts a durable increase and subsequent systemic progression? J Urol 195(6):1754–1759. CrossRefPubMedGoogle Scholar
  6. 6.
    Critz FA, Levinson AK, Williams WH, Holladay DA, Holladay CT (1997) The PSA nadir that indicates potential cure after radiotherapy for prostate cancer. Urology 49(3):322–326CrossRefPubMedGoogle Scholar
  7. 7.
    Vu CC, Haas JA, Katz AE, Witten MR (2014) Prostate-specific antigen bounce following stereotactic body radiation therapy for prostate cancer. Front Oncol 4:8. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Truesdale MD, Cheetham PJ, Hruby GW, Wenske S, Conforto AK, Cooper AB, Katz AE (2010) An evaluation of patient selection criteria on predicting progression-free survival after primary focal unilateral nerve-sparing cryoablation for prostate cancer: recommendations for follow up. Cancer J 16(5):544–549. CrossRefPubMedGoogle Scholar
  9. 9.
    van Velthoven R, Aoun F, Marcelis Q, Albisinni S, Zanaty M, Lemort M, Peltier A, Limani K (2016) A prospective clinical trial of HIFU hemiablation for clinically localized prostate cancer. Prostate Cancer Prostatic Dis 19(1):79–83. CrossRefPubMedGoogle Scholar
  10. 10.
    Habibian DJ, Katz AE (2016) Emerging minimally invasive procedures for focal treatment of organ-confined prostate cancer. Int J Hyperth. Google Scholar
  11. 11.
    Center MSKC (2017) Prostate cancer nomograms: PSA doubling time. Accessed Nov 2017
  12. 12.
    Bahn D, de Castro Abreu AL, Gill IS, Hung AJ, Silverman P, Gross ME, Lieskovsky G, Ukimura O (2012) Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol 62(1):55–63. CrossRefPubMedGoogle Scholar
  13. 13.
    Ohori MEJ, Koh H (2006) Is focal therapy reasonable in patients with early stage prostate cancer (CAP)? An analysis of radical prostatectomy (RP) specimens. J Urol 175:507Google Scholar
  14. 14.
    D’amico AV, Chen M-H, Roehl KA, WJ Catalona (2004) Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 351(2):125–135CrossRefPubMedGoogle Scholar
  15. 15.
    Partin AW, Pearson JD, Landis PK, Carter HB, Pound CR, Clemens JQ, Epstein JI, Walsh PC (1994) Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Urology 43(5):649–659CrossRefPubMedGoogle Scholar
  16. 16.
    Kongnyuy M, Lipsky MJ, Islam S, Robins DJ, Hager S, Halpern DM, Kosinski KE, Schiff JT, Corcoran AT, Wenske S, Katz AE (2017) Predictors of biochemical recurrence after primary focal cryosurgery (hemiablation) for localized prostate cancer: a multi-institutional analytic comparison of Phoenix and Stuttgart criteria. Urol Oncol. Google Scholar
  17. 17.
    Koppie TM, Shinohara K, Grossfeld GD, Presti JC Jr, Carroll PR (1999) The efficacy of cryosurgical ablation of prostate cancer: the University of California, San Francisco experience. J Urol 162(2):427–432CrossRefPubMedGoogle Scholar
  18. 18.
    Kim DN, Straka C, Cho LC, Lotan Y, Yan J, Kavanagh B, Raben D, Cooley S, Brindle J, Xie XJ, Pistenmaa D, Timmerman R (2017) Early and multiple PSA bounces can occur following high-dose prostate stereotactic body radiation therapy: subset analysis of a phase 1/2 trial. Pract Radiat Oncol 7(1):e43–e49. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Michael Kongnyuy
    • 1
    Email author
  • Shahidul Islam
    • 2
  • Alfred K. Mbah
    • 3
  • Daniel M. Halpern
    • 1
  • Glenn T. Werneburg
    • 4
  • Kaitlin E. Kosinski
    • 1
  • Connie Chen
    • 4
  • David J. Habibian
    • 5
  • Jeffrey T. Schiff
    • 1
  • Anthony T. Corcoran
    • 1
  • Aaron E. Katz
    • 1
  1. 1.Department of UrologyNYU-Winthrop HospitalMineolaUSA
  2. 2.Department of BiostatisticsNYU-Winthrop HospitalMineolaUSA
  3. 3.University of South Florida College of Public HealthTampaUSA
  4. 4.Stony Brook University School of MedicineStony BrookUSA
  5. 5.St George’s University School of MedicineTrue BlueGrenada

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