Abstract: PD56-09
Sources of Funding: Department of Urology, Winthrop University Hospital.

Introduction

Determination of biochemical (BCR) recurrence in patients who undergo primary focal cryosurgery (PFC) for organ confined prostate cancer (PCa) is controversial. We aim to evaluate prostate specific antigen (PSA) trends in post PFC patients.

Methods

A single-center retrospective review of patients from our IRB-approved database who underwent PFC was performed. Patients were followed with serial PSAs and BCR was determined using the Phoenix (PD: PSA nadir + 2 ng/ml) and Stuttgart (SD: PSA nadir + 1.2 ng/ml) definitions. PSA bounce was assessed using 2 different definitions (B1: increase in PSA of 0.4 in first 6 months and any drop thereafter, B2: increase in PSA of ≥0.2 above nadir and then a drop to/below nadir) Age, prostate volume, D&[prime]Amico risk, Gleason score, PSA variables and kinetics overtime were assessed between those who experienced BCR versus not. Various PSA permutations were analyzed.

Results

123 (94.6%) consecutive patients who had >1 PSA follow-up values were included in our analysis. Median (range) age and follow-up time was 66 (48-82) years and 19 (6.3-68.6) months respectively. 11 (8.9%, 7B1; 4B2) patients experienced PSA bounce and a median percent drop in first post-PFC PSA of 80.0 (0.0-98.7) was not associated with BCR, p=0.301. PSA values in both groups increased over time but the rate of change was significantly higher in patients who experienced BCR compared to those who did not [median PSA velocity: 0.1 vs 0.04, p=0.003]. Other PSA variables associated with experiencing BCR were higher pre-PFC PSA (7.2 vs 5.4 ng/ml, p=0.003) and higher PSA nadir (1.3 vs 1 ng/ml, p=0.012).

Conclusions

Higher PSA velocity, nadir and pre-PFC PSA may help raise suspicion for BCR. In the future with validation, these variables could serve as the components of PFC-specific BCR criteria.

Funding

Department of Urology, Winthrop University Hospital.