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Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate.

Publication ,  Journal Article
Elshafei, A; Tay, KJ; Kara, O; Malkoc, E; Nyame, Y; Arora, H; Hatem, A; Patel, SA; Lugnani, F; Polascik, TJ; Jones, JS
Published in: Clin Genitourin Cancer
April 2018

INTRODUCTION: The purpose of this study was to assess the relationship of total prostate volume (TPV) and oncologic outcomes following focal prostate cryoablation. MATERIALS AND METHODS: A query of the Cryo On-Line Database (COLD) registry for men who underwent primary focal prostate cryoablation revealed 829 patients with complete data. The impact of TPV on oncologic outcomes including progression-free survival (PFS) and post-cryoablation biopsy outcome was assessed using Kaplan-Meier curves and Cox and logistic regression models. RESULTS: The median follow-up time was 25.2 months (interquartile range [IQR], 12.7-48.2 months). The median age at time of treatment was 68 years (IQR, 63-74 years) with median prostate-specific antigen (PSA) 5.6 ng/mL (IQR, 4.4-7.5 ng/mL), and median TPV 35 mL (IQR, 26.5-46 mL). PFS was achieved in 83.2%, with positive post-cryoablation biopsy detected in 81 (35.7%) of 228 patients. Higher TPV was associated with higher biochemical progression (BP) using the Phoenix definition (39 vs. 34.5 mL; P = .003) and was an independent predictor of BP (hazard ratio, 1.01; P = .02). Conversely, men who had a positive post-cryoablation biopsy had significantly smaller median TPV on univariate and multivariate analyses (31 vs. 39 mL; P < .001), (odds ratio, 0.97; P = .001), respectively. Higher median pretreatment PSA density was associated with higher BP (0.18 vs. 0.16; P = .005) and positive post-cryoablation biopsy rates (0.2 vs. 0.16; P = .003). CONCLUSION: Prostate volume has contradictory effects on BP and post-cryoablation biopsy outcome in men who underwent primary focal prostate cryoablation. Remnant viable tissue in larger prostates continues to produce more PSA over time, which may impact BP. This may raise the need to develop a new definition for oncologic success following focal gland therapy rather than the American Society for Radiation Oncology (ASTRO) and Phoenix definitions.

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Published In

Clin Genitourin Cancer

DOI

EISSN

1938-0682

Publication Date

April 2018

Volume

16

Issue

2

Start / End Page

e477 / e482

Location

United States

Related Subject Headings

  • Tumor Burden
  • Treatment Outcome
  • Survival Analysis
  • Prostatic Neoplasms
  • Prostate-Specific Antigen
  • Progression-Free Survival
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Logistic Models
 

Citation

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Elshafei, A., Tay, K. J., Kara, O., Malkoc, E., Nyame, Y., Arora, H., … Jones, J. S. (2018). Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate. Clin Genitourin Cancer, 16(2), e477–e482. https://doi.org/10.1016/j.clgc.2017.10.009
Elshafei, Ahmed, Kae Jack Tay, Onder Kara, Ercan Malkoc, Yaw Nyame, Hans Arora, Asmaa Hatem, et al. “Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate.Clin Genitourin Cancer 16, no. 2 (April 2018): e477–82. https://doi.org/10.1016/j.clgc.2017.10.009.
Elshafei A, Tay KJ, Kara O, Malkoc E, Nyame Y, Arora H, et al. Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate. Clin Genitourin Cancer. 2018 Apr;16(2):e477–82.
Elshafei, Ahmed, et al. “Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate.Clin Genitourin Cancer, vol. 16, no. 2, Apr. 2018, pp. e477–82. Pubmed, doi:10.1016/j.clgc.2017.10.009.
Elshafei A, Tay KJ, Kara O, Malkoc E, Nyame Y, Arora H, Hatem A, Patel SA, Lugnani F, Polascik TJ, Jones JS. Associations Between Prostate Volume and Oncologic Outcomes in Men Undergoing Focal Cryoablation of the Prostate. Clin Genitourin Cancer. 2018 Apr;16(2):e477–e482.

Published In

Clin Genitourin Cancer

DOI

EISSN

1938-0682

Publication Date

April 2018

Volume

16

Issue

2

Start / End Page

e477 / e482

Location

United States

Related Subject Headings

  • Tumor Burden
  • Treatment Outcome
  • Survival Analysis
  • Prostatic Neoplasms
  • Prostate-Specific Antigen
  • Progression-Free Survival
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Logistic Models