THE "NEW" PROSTATE CANCER INFOLINK

According to a new article in the Journal of Endourology, the authors have identified an optimal PSA nadir level after whole-gland salvage prostate cryoablation among patients with recurrent prostate cancer.

Kovac et al. used data from a cohort of 486 prostate cancer patients from the Cryo On-Line Database (COLD), all of whom were treated with whole-gland, salvage cryotherapy for radiorecurrent prostate cancer after primary radiation therapy for localized prostate cancer. All of the patients were also hormone-naive, i.e., they had received no form of androgen deprivation therapy (ADT) before, in conjunction with, or after their primary radiation therapy.

The following data were available on all of the 486 patients in this cohort: age, race, initial PSA, pre-salvage PSA, initial Gleason score, Gleason score at pre-salvage biopsy, clinical stage, and follow-up PSA values.

Kovacs et al. have shown that:

• A nadir PSA level of ≤ 0.4 ng/ml post-salvage cryotherapy was most strongly associated with biochemical progression-free survival (bPFS).
• 5-year estimates for bPFS were
  • 75.5 percent for all patients with nadir PSA levels < 0.4 ng/ml
  • 22.1 percent for all patients with nadir PSA levels ≥ 0.4 ng/ml
• When stratified by pre-salvage PSA level, 5-year estimates for bPFS  were
  • 78.5 percent for patients with nadir PSA levels < 0.4 ng/ml and a pre-salvage PSA level of < 4 ng/ml
  • 17.9 percent for patients with nadir PSA levels ≥ 0.4 ng/ml and a pre-salvage PSA level of < 4 ng/ml
  • 77.1 percent for patients with nadir PSA levels < 0.4 ng/ml and a pre-salvage PSA level of 4 to 10 ng/ml
  • 15.7 percent for patients with nadir PSA levels ≥ 0.4 ng/ml and a pre-salvage PSA level of 4 to 10 ng/ml
  • 77.8 percent for patients with nadir PSA levels < 0.4 ng/ml and a pre-salvage PSA level of > 10 ng/ml
  • 16.8 percent for patients with nadir PSA levels ≥ 0.4 ng/ml and a pre-salvage PSA level of > 10 ng/ml

Kovacs et al conclude that the best objective indicator of biochemical success following whole-gland salvage cryoablation of the prostate among hormone-naive patients who have radiorecurrent prostate cancer is a PSA nadir of < 0.4 ng/ml.

Having an established target for nadir PSA among this group of patients is clearly helpful for patients and for the cryotherapy community. One wonders whether a similar target for nadir PSA levels could be established for patients receiving high-intensity focused ultrasound (HIFU) as salvage therapy based a comparable set of radiorecurrent patients. The current database may be too small to set such a goal (yet).

Filed under: Living with Prostate Cancer, Management, Treatment | Tagged: cryotherapy, nadir, outcome, PSA, radiorecurrent, salvage |