1057 THE IMPACT OF PROSTATE CANCER NATURAL HISTORY ON FOCAL ABLATION RESULTS (2010)

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 20101057 THE IMPACT OF PROSTATE CANCER NATURAL HISTORY ON FOCAL ABLATION RESULTS Ari Adamy, David S. Yee, Daher C. Chade, Victor E. Reuter, Karim Touijer, James Eastham, Peter T. Scardino, and Bertrand Guillonneau Ari AdamyAri Adamy More articles by this author , David S. YeeDavid S. Yee More articles by this author , Daher C. ChadeDaher C. Chade More articles by this author , Victor E. ReuterVictor E. Reuter More articles by this author , Karim TouijerKarim Touijer More articles by this author , James EasthamJames Eastham More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2181AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the prostate cancer natural history on the results of focal ablation studies, applying the most common definitions of focal therapy success in a group of patients under active surveillance (AS) protocol. METHODS From March 1993 to April 2009 we identified 258 patients that met the inclusion criteria (PSA ≤10 ng/ml, Gleason score ≤6, ≤ 3 positive cores, no more than 50% of a core involved by tumor) on two staging biopsies and elected to undergo AS. To be included in our AS protocol patients had a second confirmatory biopsy and an endorectal MRI excluding gross tumor. Patients without a third biopsy during follow-up were excluded, leaving a final study population of 160 patients. Three definitions for biochemical recurrence (BCR) commonly used in focal therapy studies were analyzed, including ASTRO definition (three consecutive rises in the PSA), Phoenix definition (nadir + 2ng/ml) and Stuttgart definition (nadir + 1.2ng/ml). Patients with a positive biopsy were considered failure even if the criteria were met. Kaplan-Meier methods were used to plot the probability of success over time for each definition of failure. RESULTS The median age of the cohort was 64 years, with a median PSA of 4.3 ng/ml. The majority of patients were clinical stage T1c (88%) and had Gleason score 6 (96%) on the first biopsy. After the initial biopsy, 119 (79%) patients had a decrease in their PSA and reached a median PSA nadir of 3.45 ng/ml. Using ASTRO definition the progression free probability at 2 and 5 years was 84% and 59%, respectively. Using the Phoenix definition, 70% and 44% of the patients in AS would be considered free of BCR at 2 and 5 years, respectively, and 59% and 32% at 2 and 5 years if the Stuttgart definition was used. Sixty five patients (41%) had negative biopsies during the follow-up period and would be therefore considered to succeed focal therapy. The probability of having only negative results on the subsequent biopsies was 65% and 34% at 2 and 5 years, respectively (Figure). CONCLUSIONS Between 32 to 59% of patients would achieve success by focal therapy standards at 5 years even without treatment. In light of this, results of focal ablation studies should be interpreted carefully as a significant number of patients would succeed without receiving any type of therapy. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e411-e412 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ari Adamy More articles by this author David S. Yee More articles by this author Daher C. Chade More articles by this author Victor E. Reuter More articles by this author Karim Touijer More articles by this author James Eastham More articles by this author Peter T. Scardino More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...