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- Title
Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen.
- Authors
Kovac, Evan; Elshafei, Ahmed; Tay, Kae Jack; Mendez, Melissa; Polascik, Thomas J.; Jones, J. Stephen
- Abstract
Background and Objectives: Salvage prostate cryoablation is an effective treatment for patients with localized prostate cancer relapse following primary radiotherapy. The postsalvage prostate-specific antigen (PSA) nadir that best predicts long-term biochemical progression-free survival (bPFS) is not yet defined. We sought to determine what nadir PSA best predicted success following salvage whole-gland cryoablation. Patients and 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, presalvage prostate-specific antigen (psPSA), initial Gleason score, Gleason score at presalvage biopsy, clinical stage, and follow-up PSA values. Kaplan-Meier (KM) analysis was used to calculate 5-year bPFS using the Phoenix criteria. Hazard ratio and relative risk were also analyzed. Differences among the KM estimates, at 5 years, were calculated using the log-rank test. Results: Using group thresholds, KM analysis identified nadir PSA less than or greater than 0.4 ng/mL as the nadir PSA threshold, with the greatest difference in bPFS. The KM estimated 5-year bPFS was 75.5% and 22.1% for nadir PSA <0.4 and ≥0.4 ng/mL, respectively. Stratified by psPSA, the KM estimated 5-year bPFS comparing patients with PSA nadir <0.4 vs ≥0.4 ng/mL was 78.5% and 17.9% ( p < 0.0001) for psPSA <4 ng/mL, 77.1% and 15.7% ( p < 0.0001) for psPSA 4-10 ng/mL, and 77.8% and 16.8% ( p < 0.0001) for psPSA >10 ng/mL, respectively. Conclusion: The best objective indicator of biochemical success following whole-gland salvage cryoablation of the prostate is PSA nadir <0.4 ng/mL.
- Subjects
CRYOSURGERY; PROSTATE cancer patients; DISEASE relapse; ADENOCARCINOMA; KAPLAN-Meier estimator
- Publication
Journal of Endourology, 2016, Vol 30, Issue 6, p624
- ISSN
0892-7790
- Publication type
Article
- DOI
10.1089/end.2015.0719