Русский
The correlation of PSA-nadir PSА recurrence after total HIFU-ablation in patients with localized prostate cancer
DOI: https://dx.doi.org/10.18565/urology.2020.4.79-83
R.N. Fomkin, G.E. Krupinov, A.A. Churakov, T.V. Shatylko, О.A. Fomkina, V.A. Zhmakin
1) Research Institute of Fundamental and Clinical Uronephrology Saratov State Medical University n.a. VI Razumovsky of the Ministry of Health of Russia, Saratov, Russia; 2) Institute of Urology and Human Reproductive Health First Moscow State Medical University n.a IM Sechenova of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
Objective: To study the survival rate of patients without biochemical recurrence according to the Stuttgart and Phoenix criteria in terms of their correlation with four different PSA nadir values as predictors of clinical recurrence in patients with localized prostate cancer who underwent total HIFU prostate ablation.
Material and methods. The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging® apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 – T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: ≤ 0.2 ng / ml (1 group), 0.21–0.5 ng / ml (group 2), 0.51–1 ng / ml (group 3) and> 1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups.
Results. The median (range) of the observation period for the patients was 5.3 (3–7) years, the mean time to reaching PSA nadir was 14.5±2.6 weeks. PSA nadirs ≤0.2, 0.21–0.5, 0.51–1.0 and > 1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p<0.001), according to the Phoenix definition – 94, 74, 66 and 47% (p<0.001) respectively. According to the results of the control biopsy, 601 (91.3%) patients in the 1st and 2nd groups had a negative oncological status (approximately 85%).
Conclusion. This study confirms that PSA nadir after HIFU ablation predicts biochemical recurrence-free survival and is a reliable marker that is easy to integrate into routine clinical practice.
Material and methods. The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging® apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 – T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: ≤ 0.2 ng / ml (1 group), 0.21–0.5 ng / ml (group 2), 0.51–1 ng / ml (group 3) and> 1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups.
Results. The median (range) of the observation period for the patients was 5.3 (3–7) years, the mean time to reaching PSA nadir was 14.5±2.6 weeks. PSA nadirs ≤0.2, 0.21–0.5, 0.51–1.0 and > 1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p<0.001), according to the Phoenix definition – 94, 74, 66 and 47% (p<0.001) respectively. According to the results of the control biopsy, 601 (91.3%) patients in the 1st and 2nd groups had a negative oncological status (approximately 85%).
Conclusion. This study confirms that PSA nadir after HIFU ablation predicts biochemical recurrence-free survival and is a reliable marker that is easy to integrate into routine clinical practice.
About the Autors
Corresponding author: R.N. Fomkin – Cand.Med.Sci., Associate Professor of the Department of Urology, Saratov State Medical University named after VI Razumovsky Ministry of Health of Russia, Research Institute of Fundamental and Clinical Uronephrology, Saratov, Russia; e-mail: rnfomkin@mail.ru
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