Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen

Evan Z. Kovac, Ahmed Elshafei, Kae Jack Tay, Melissa Mendez, Thomas J. Polascik, J. Stephen Jones

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)624-631
Number of pages8
JournalJournal of Endourology
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Cryosurgery
Prostate-Specific Antigen
Disease-Free Survival
Prostate
Kaplan-Meier Estimate
Neoplasm Grading
Prostatic Neoplasms
Radiotherapy
Databases
Hormones
Biopsy
Recurrence

ASJC Scopus subject areas

  • Urology

Cite this

Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation : Defining Success with Nadir Prostate-Specific Antigen. / Kovac, Evan Z.; Elshafei, Ahmed; Tay, Kae Jack; Mendez, Melissa; Polascik, Thomas J.; Jones, J. Stephen.

In: Journal of Endourology, Vol. 30, No. 6, 01.06.2016, p. 624-631.

Research output: Contribution to journalArticle

Kovac, Evan Z. ; Elshafei, Ahmed ; Tay, Kae Jack ; Mendez, Melissa ; Polascik, Thomas J. ; Jones, J. Stephen. / Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation : Defining Success with Nadir Prostate-Specific Antigen. In: Journal of Endourology. 2016 ; Vol. 30, No. 6. pp. 624-631.
@article{92610af3310e4e728725951816c719f8,
title = "Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen",
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.",
author = "Kovac, {Evan Z.} and Ahmed Elshafei and Tay, {Kae Jack} and Melissa Mendez and Polascik, {Thomas J.} and Jones, {J. Stephen}",
year = "2016",
month = "6",
day = "1",
doi = "10.1089/end.2015.0719",
language = "English (US)",
volume = "30",
pages = "624--631",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "6",

}

TY - JOUR

T1 - Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation

T2 - Defining Success with Nadir Prostate-Specific Antigen

AU - Kovac, Evan Z.

AU - Elshafei, Ahmed

AU - Tay, Kae Jack

AU - Mendez, Melissa

AU - Polascik, Thomas J.

AU - Jones, J. Stephen

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84975230852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975230852&partnerID=8YFLogxK

U2 - 10.1089/end.2015.0719

DO - 10.1089/end.2015.0719

M3 - Article

C2 - 26915721

AN - SCOPUS:84975230852

VL - 30

SP - 624

EP - 631

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 6

ER -