Outcomes after HIFU and prognosis based on post-HIFU PSA nadir levels
Posted Mar 16 2011 12:00am
A new analysis of data from the multi-center @-Registry of patients undergoing Ablatherm-based high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer suggests that nadir levels of PSA post-treatment can be used to predict the probability of biochemical progression-free survival (bPFS) at 5 years of follow-up.
Ganzer et al. conducted a retrospective analysis of data based on 804 patients whose pretreatment data and post-treatment PSA levels have been reported to the @-Registry. Post-treatment PSA levels was measured at 3-month intervals.
The researchers categorized each of these 804 men into one of four groups based on their lowest (nadir) PSA levels, as follows:
Group 1 PSA nadir level ≤ 0.20 ng/ml
Group 2 PSA nadir level 0.21-0.50 ng/ml
Group 3 PSA nadir level 0.51-1.00 ng/ml
Group 4 PSA nadir level >1.00 ng/ml.
Biochemical progression (i.e., treatment failure) was determined according to both the Stuttgart definition (PSA nadir + 1.2 ng/ml) and the Phoenix definition (PSA nadir + 2 ng/ml). All patients received a post-treatment biopsy between 3 and 6 months post-HIFU or if a PSA level was recorded that suggested the clinical relevance of such a procedure.
The resulst of the study are reported to be as follows:
Based on the Stuttgart definition of treatment failure, 5-year bPFS was achieved by
Based on the Stuttgart definition of treatment failure, 5-year bPFS was achieved by
Significantly more patients had a negative biopsy in Group 1 than in Groups 2-4 (91.6 vs 73.1 percent; P < 0.001).
The authors conclude that based on this data set the PSA nadir after HIFU predicts biochemical bPFS in a statistically significant manner. However, they also carefully note that this study is “limited by its retrospective nature and variations in clinical practice” among the participating centers.
It is (perhaps) unfortunate that this study didn’t offer a similar outcomes analysis based on the Gleason grades and or the risk (low-, intermediate-, high-) of the patients. What is clear from this registry-based cohort is that only men who have a nadir PSA level < 0.2 ng/ml post-HIFU can have a really reasonable expectation of a good outcome at 5 years post-HIFU based on the Ablatherm system. It would be interesting to see a comparable analysis of data from 800+ men treated using the Sonablate system.
A new analysis of data from the multi-center @-Registry of patients undergoing Ablatherm-based high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer suggests that nadir levels of PSA post-treatment can be used to predict the probability of biochemical progression-free survival (bPFS) at 5 years of follow-up.
Ganzer et al. conducted a retrospective analysis of data based on 804 patients whose pretreatment data and post-treatment PSA levels have been reported to the @-Registry. Post-treatment PSA levels was measured at 3-month intervals.
The researchers categorized each of these 804 men into one of four groups based on their lowest (nadir) PSA levels, as follows:
Biochemical progression (i.e., treatment failure) was determined according to both the Stuttgart definition (PSA nadir + 1.2 ng/ml) and the Phoenix definition (PSA nadir + 2 ng/ml). All patients received a post-treatment biopsy between 3 and 6 months post-HIFU or if a PSA level was recorded that suggested the clinical relevance of such a procedure.
The resulst of the study are reported to be as follows:
The authors conclude that based on this data set the PSA nadir after HIFU predicts biochemical bPFS in a statistically significant manner. However, they also carefully note that this study is “limited by its retrospective nature and variations in clinical practice” among the participating centers.
It is (perhaps) unfortunate that this study didn’t offer a similar outcomes analysis based on the Gleason grades and or the risk (low-, intermediate-, high-) of the patients. What is clear from this registry-based cohort is that only men who have a nadir PSA level < 0.2 ng/ml post-HIFU can have a really reasonable expectation of a good outcome at 5 years post-HIFU based on the Ablatherm system. It would be interesting to see a comparable analysis of data from 800+ men treated using the Sonablate system.