PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure

Title: PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure
Authors: Shah, TT
Peters, M
Kanthabalan, A
McCartan, N
Fatola, Y
Van Zyp, JVDV
Van Vulpen, M
Freeman, A
Moore, CM
Arya, M
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: BACKGROUND: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. METHODS: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA4nadir+2 ng ml − 1 )), start of systemic therapies or metastases. RESULTS: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml − 1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgendeprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir o0.5 ng ml − 1 , 15/50 (30%) had a nadir ⩾ 0.5 ng ml − 1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir o0.5 ng ml − 1 , nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (Po0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). CONCLUSIONS: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
Issue Date: 19-Jul-2016
Date of Acceptance: 20-Mar-2016
ISSN: 1365-7852
Publisher: Nature Publishing Group
Start Page: 311
End Page: 316
Journal / Book Title: Prostate Cancer and Prostatic Diseases
Volume: 19
Issue: 3
Copyright Statement: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit by/4.0/ © The Author(s) 2016
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
Combined Modality Therapy
Disease Progression
Follow-Up Studies
High-Intensity Focused Ultrasound Ablation
Middle Aged
Multimodal Imaging
Neoplasm Grading
Prostate-Specific Antigen
Prostatic Neoplasms
Radiotherapy, Adjuvant
Survival Analysis
Treatment Outcome
1112 Oncology And Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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