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

Kongnyuy, Michael; Islam, Shahidul; Mbah, Alfred K.; Halpern, Daniel; Werneburg, Glenn T.; Kosinski, Kaitlin E.; Chen, Connie; Habibian, David J.; Schiff, Jeffrey; Corcoran, Anthony; Katz, Aaron E.

doi:10.1007/s00345-017-2130-5

Cited by 15 publications

(14 citation statements)

References 15 publications

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“…Prostate specific antigen measurements were performed at short intervals (every 1-3 months) post-operatively. Biochemical recurrence (BCR) was determined using Phoenix criterion (PSA nadir + 2 ng/ml) [13,14]. If the PSA level increased to the pre-treatment level, we recommended a 5-mm transperineal template mapping biopsy (TTMB).…”

Section: Patient Follow-up (Psa Mri and Toxicity)mentioning

confidence: 99%

Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer

Kunogi¹,

Wakumoto²,

Kawamoto³

et al. 2020

jcb

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Purpose: To prospectively investigate the efficacy and feasibility of focal low-dose-rate (LDR) prostate brachytherapy for low-and intermediate-risk prostate cancer.Material and methods: Between October 2014 and May 2019, nineteen low-and intermediate-risk prostate cancer patients who presented with abnormality on both diffusion-weighted and T2-weighted magnetic resonance imaging (MRI) underwent focal LDR brachytherapy at our institution. Focal gross tumor volume (F-GTV) was delineated on transrectal ultrasound, based on abnormality seen on fused T2-weighted MRI. F-GTV was expanded by 5 mm, as a safety margin, to create focal clinical target volume (F-CTV). Prescribed dose to F-CTV was 145 Gy. Biochemical recurrence (BCR) was determined using Phoenix criterion (prostate specific antigen nadir + 2 ng/ml). Pre-and post-implant dosimetry data were compared using non-parametric Wilcoxon's rank sum test. Treatment-related toxicities were evaluated using common terminology criteria for adverse events.Results: Mean F-CTV D 90% was significantly lower in the post-implant evaluation than in intraoperative planning (p = 0.004). On post-implant dosimetry, the mean D 90% for F-GTV and mean V 100% for the entire prostate were 222 Gy and 35%, respectively. Median follow-up time for all patients was 31 months. BCR occurred in one patient after 23 months. Kaplan-Meier 2-year BCR-free rate was 92.9% (95% confidence interval [CI]: 79.4-100%). No patients had grade 1 or greater gastrointestinal toxicity. Three patients who were taking α-blockers to treat benign prostatic hyperplasia (present before brachytherapy), experienced no treatment-related genitourinary toxicities. Two patients suffered from temporary grade 2 urinary frequency. None of the remaining patients experienced grade 2 or higher genitourinary toxicity.Conclusions: Focal LDR prostate brachytherapy appears acceptable for MRI-based index tumors, with a low cumulative incidence of BCR. Such brachytherapy might offer a feasible minimally invasive therapeutic option for localized prostate cancer.

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Section: Patient Follow-up (Psa Mri and Toxicity)mentioning

confidence: 99%

Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer

Kunogi¹,

Wakumoto²,

Kawamoto³

et al. 2020

jcb

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“…The lack of clarity arises due to the intrinsically personalized nature of focal treatment, where a small treatment in a large prostate will have less of an impact on PSA than a hemi-ablation in a small gland. However, PSA kinetics and particularly PSA nadir have been proposed as potential post-operative tools to predict FT failure [9,10], and to tailor the follow up MRI schedule for men. In the current study we sought to determine the relationship of the percentage of PSA reduction (%PSA reduction) after FT using high-intensity focused ultrasound (HIFU) in predicting the risk of for any additional treatment and radical treatment.…”

mentioning

confidence: 99%

“…Gleason score, clinical stage, PSA and prostate volume). Even though PSA nadir had been proposed as useful post-FT tool [9,10], its value is highly influenced by several factors such as pre-operative PSA, prostate volume and the prostatic tissue ablated during treatment. The use of %PSA reduction allows to overcome all these confounders.…”

mentioning

confidence: 99%

The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series

et al. 2020

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Focal therapy (FT) for prostate cancer (PCa) is emerging as a novel therapeutic approach for patients with low to intermediate-risk disease, in order to provide acceptable oncological control, whilst avoiding the side effects of radical treatment. Evidence regarding the ideal follow up strategy, and the significance of PSA kinetics post treatment is needed. In this study we aimed at assessing the value of the percentage of PSA reduction (%PSA reduction) after FT in predicting the likelihood of any additional treatment, or any radical treatment. We retrospectively analysed a multicentre cohort of 688 men receiving FT for PCa. Overall, the rates of any additional treatment, and of any radical treatment rate were 30% and 13%, respectively. Median follow-up was 41 months. The median %PSA reduction after FT was 73%. At Cox multivariable analysis, %PSA reduction was an independent predictor of any additional treatment (hazard ratio [HR]: 0.97; p<0.001) and of any radical treatment (HR: 0.96; p<0.001) after FT. For %PSA reduction > 90%, the probability of any additional treatment within 5 years was 20%. Conversely, for %PSA reduction < 10% the probability of receiving any additional treatment within 5 years was roughly 70%. This study is the first to assess the role of %PSA reduction in the largest multicenter cohort of men receiving FT for PCa. Given the lack of standardized follow-up strategies in FT field, the use of the %PSA reduction should be considered. Patient summary:The %PSA reduction is a useful tool to assess men following FT. It can assist the urologist in setting up an appropriate follow-up and during post-FT patients counselling.

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“…The search protocol yielded 13 studies that were identified for inclusion after thorough assessment (Figure 1) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Eight studies were single center series, while three were multicenter cohorts and two were derived from the Cryo On-Line Data (COLD) multi-center registry.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven (84.6%) studies specifically analyzed oncologic outcomes, which are presented in 22.8 months (15), two studies quoted 3-year BCRFS from 56-62.5% (13,16), and two articles described 5-year rates from 62-70% (14,21). Nine (69.2%) studies reported follow-up biopsy data, with 23.8-96.6% of patients undergoing post-cryoablation biopsy.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Focal cryotherapy for prostate cancer: a contemporary literature review

Kotamarti¹,

Polascik²

2023

Ann Transl Med

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Objective: To perform a comprehensive review of the contemporary literature regarding both functional and oncologic outcomes after primary focal cryotherapy for prostate cancer (PCa), providing these results as a foundation for discussing recent developments in the realm of focal therapy. Background: Traditional treatments for PCa are often associated with debilitating functional side effects for patients. Due to advances in imaging and biopsy strategies, focal ablative therapies recently have garnered much interest and offer an alternative primary treatment for PCa patients with localized disease. Focal cryoablation utilizes heat extraction from tissues to generate an iceball and cause tissue destruction while sparing uninvolved prostatic regions. Optimized patient selection and postoperative management continue to be areas of interest and study as the field continues to develop. Methods: A search was performed of the PubMed and Embase databases to identify articles pertaining to primary focal PCa cryoablation since our group's last comprehensive review in 2016. Conclusions: Primary focal cryoablation for PCa offers optimized functional outcomes and a favorable adverse event profile. True evaluation of oncologic outcomes is hampered by lack of long-term follow-up and highly variable clinical endpoints across these studies. Nonetheless, outcomes appear adequate in the shortto medium-term time frame. Utilization of focal cryoablation is expected to grow with continued refinement of patient selection and management options in cases of treatment failure.

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

Cited by 15 publications

References 15 publications

Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer

Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer

The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series

Focal cryotherapy for prostate cancer: a contemporary literature review

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