Category: MIS Image Guided/ Focal-cryo/RFA/HIFU: Prostate

MP23-17 - Comparison of definitions of biochemical recurrence following focal or total cryotherapy for organ-confined prostate cancer

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Prostate cancer often has a slow progression, and thus biochemical recurrence (BCR), or a rising post-treatment PSA, is a commonly-used proxy for prostate cancer treatment success, as it pre-dates metastasis and mortality by several years.  Cryotherapy is an effective treatment for organ-confined prostate cancer, yet there remains no consensus on a precise definition of BCR following cryotherapy.  Therefore, we sought to compare various definitions of BCR following cryotherapy for their effectiveness in predicting adverse oncological outcomes.

Methods :

16 definitions of BCR following cryotherapy were identified in the literature and applied to 297 organ-confined prostate cancer patients who underwent primary cryotherapy as identified in our IRB-approved database.  Patients were stratified based on whether they received focal (hemiablation) or total cryotherapy. Specificity, sensitivity, positive and negative predictive values, and area under the ROC curve (AUC) were calculated for each definition for prediction of post-treatment positive biopsy, progression to salvage treatment, metastasis, and overall survival.  Kaplan-Meier curves for BCR definitions were generated, and median BCR-free survival and 95% confidence intervals were determined.

Results :

Median follow-up was 30 months for focal cryotherapy patients and 34 months for total patients.  In the focal cryotherapy cohort, the definition of “absolute value of PSA ≥4 ng/ml” had the greatest AUC for positive biopsy (0.71) and progression to salvage treatment (0.70), and “PSA nadir +3 ng/ml” had the greatest AUC for metastasis (0.83).  In the total cryotherapy cohort, “absolute value of PSA ≥4 ng/ml” had the greatest AUC for positive biopsy (0.79), “3 consecutive PSA rises” for progression to salvage treatment (0.78), and “PSA nadir +4 ng/ml” for metastasis (0.79).  “Absolute value of PSA ≥4 ng/ml” was the only definition with AUC ≥0.70 for positive biopsy, salvage treatment, and metastasis for both the focal and total cohorts, and was associated with a median BCR-free survival of 35 months for focal patients (CI: 28–42) and 37 months for total patients (CI: 29–45) (Figure).

Conclusions :

The BCR definition of “absolute value of PSA ≥4 ng/ml” was most consistently best at discriminating between oncological outcomes in our cohorts of focal and total cryotherapy patients.

Glenn Werneburg

Stony Brook, New York

Roy Gildersleeve

Mineola, New York

Amanda Le Sueur

Mineola, New York

Jose Salcedo

Mineola, New York

Aaron Katz

Chairman of Urology
NYU Winthrop hospital
Mineola, New York

Dr. Aaron E katz M.D. is the chairman of urology At NYU Winthrop University Hospital. He is a pioneer in the area of prostate cancer treatment using percutaneous guided cryotherapy. He has performed over 3000 of these procedures both in the primary , salvage and focal setting. He also has interests in holistic therapies and has a large database of patients on active holistic surveillance using dietary strategies and vitamin supplements to reduce or prevent PSA progression In Maine with early-stage prostate cancer. He has published over 200 scientific articles and has lectured nationally and internationally on the role of minimally invasive therapies for prostate cancer.
Dr. katz obtained his urology residency training in Brooklyn and then completed a urologic oncology fellowship at Columbia medical center where he spent most of his caree and artained endowed professorahip . In the last six years he has taken on the leadership role as chairman of urology at NYU Winthrop in Mineola New York. He sees patients in Garden City Long Island as well as in Manhattan.