Prostate Specific Antigen Criteria to Diagnose Failure of Cancer Control following Focal Therapy of Nonmetastatic Prostate Cancer Using High Intensity Focused Ultrasound
2020; Lippincott Williams & Wilkins; Volume: 203; Issue: 4 Linguagem: Inglês
10.1097/ju.0000000000000747
ISSN1527-3792
AutoresPhilipp Huber, Naveed Afzal, Manit Arya, Silvan Boxler, Tim Dudderidge, Mark Emberton, Stephanie Guillaumier, Richard G. Hindley, Feargus Hosking‐Jervis, Lucas Leemann, Henry Lewi, Neil McCartan, Caroline M. Moore, Raj Nigam, Chris Odgen, Raj Persad, George N. Thalmann, Jaspal Virdi, Mathias Winkler, Hashim U. Ahmed,
Tópico(s)Urinary Bladder and Prostate Research
ResumoNo AccessJournal of UrologyAdult Urology1 Apr 2020Prostate Specific Antigen Criteria to Diagnose Failure of Cancer Control following Focal Therapy of Nonmetastatic Prostate Cancer Using High Intensity Focused Ultrasound Philipp M. Huber, Naveed Afzal, Manit Arya, Silvan Boxler, Tim Dudderidge, Mark Emberton, Stephanie Guillaumier, Richard G. Hindley, Feargus Hosking-Jervis, Lucas Leemann, Henry Lewi, Neil McCartan, Caroline M. Moore, Raj Nigam, Chris Odgen, Raj Persad, George N. Thalmann, Jaspal Virdi, Mathias Winkler, and Hashim U. Ahmed Philipp M. HuberPhilipp M. Huber Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland Department of Urology, Bern and St. Anna Klinik Lucerne, Lucerne, Switzerland Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , Naveed AfzalNaveed Afzal Department of Urology, Dorset County Hospital NHS Trust, Dorset, United Kingdom More articles by this author , Manit AryaManit Arya Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom More articles by this author , Silvan BoxlerSilvan Boxler Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland More articles by this author , Tim DudderidgeTim Dudderidge Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom More articles by this author , Mark EmbertonMark Emberton Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author , Stephanie GuillaumierStephanie Guillaumier Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author , Richard G. HindleyRichard G. Hindley Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, United Kingdom Financial interest and/or other relationship with Sonacare US. More articles by this author , Feargus Hosking-JervisFeargus Hosking-Jervis Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , Lucas LeemannLucas Leemann Department of Political Science, University of Zurich, Zürich, Switzerland More articles by this author , Henry LewiHenry Lewi Springfield Hospital, Chelmsford, United Kingdom More articles by this author , Neil McCartanNeil McCartan Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author , Caroline M. MooreCaroline M. Moore Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author , Raj NigamRaj Nigam Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, United Kingdom More articles by this author , Chris OdgenChris Odgen Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom More articles by this author , Raj PersadRaj Persad Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom More articles by this author , George N. ThalmannGeorge N. Thalmann Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland More articles by this author , Jaspal VirdiJaspal Virdi Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom More articles by this author , Mathias WinklerMathias Winkler Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , and Hashim U. AhmedHashim U. Ahmed †Correspondence: Imperial College London, Fulham Palace Rd., London, W6 8RF, United Kingdom ( E-mail Address: [email protected] Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000747AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether prostate specific antigen criteria after focal high intensity focused ultrasound to treat prostate cancer could diagnose treatment failure. Materials and Methods: A total of 598 patients in a prospectively maintained national database underwent focal high intensity focused ultrasound with a Sonablate® 500 device from March 2007 to November 2016. Followup consisted of 3-month clinic visits and prostate specific antigen testing in year 1 with prostate specific antigen measurement every 6 to 12 months and multiparametric magnetic resonance imaging with biopsy for magnetic resonance imaging suspicious for recurrence. Treatment failure was considered any secondary treatment, tumor recurrence with Gleason 3 + 4 or greater disease on prostate biopsy without further treatment or metastasis and/or prostate cancer related mortality. To diagnose failure we evaluated a series of nadir + x thresholds with x values of 0.1 to 2.0 ng/ml. Results: Median patient age was 65 years (IQR 60–71) and the median Gleason score was 7 (range 6-9). Gleason 3 + 4 or greater disease was present in 80% of cases. Tumors were radiologically staged as T1c-T2c in 522 of the 596 patients (88%) and as T3a/b in 74 (12.4%). Baseline median prostate specific antigen was 7.80 ng/ml (IQR 5.96–10.45) in failed cases and 6.77 ng/ml (IQR 2.65–9.71) in cases without failure. Optimal performance according to the Youden index to indicate the most appropriate nadir + x at all analyzed time points at 3-month intervals showed that nadir + 1.0 ng/ml would have 27.3% to 100% sensitivity and 39.4% to 85.6% specificity depending on the time of evaluation in the first 3 years. Nadir + 1.5 ng/ml showed 18.2% to 100% sensitivity and 60.6% to 91.8% specificity with nadir + 2.0 ng/ml leading to similar sensitivity and specificity ranges. Nadir + 1.0 ng/ml at 12 months and nadir + 1.5 ng/ml at 24 and 36 months had 100% sensitivity and 96.1% to 100% negative predictive value. Conclusions: Following focal high intensity focused ultrasound a prostate specific antigen nadir of 1.0 ng/ml at 12 months and 1.5 ng/ml at 24 to 36 months might be used to triage men requiring magnetic resonance imaging and biopsy. These data need prospective validation. References 1. : The role of focal therapy in the management of localised prostate cancer: a systematic review. Eur Urol 2014; 66: 732. Google Scholar 2. : Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol 2012; 13: 622. Google Scholar 3. : Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol 2015; 68: 927. Google Scholar 4. : Focal therapy: patients, interventions, and outcomes—a report from a consensus meeting. Eur Urol 2015; 67: 771. 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Google Scholar Supported by the United Kingdom MRC (Medical Research Council) (HUA) and an unrestricted grant from Sonacare (ME and HUA). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCathelineau X and Sanchez-Salas R (2020) Editorial CommentJournal of Urology, VOL. 204, NO. 5, (949-949), Online publication date: 1-Nov-2020.Smith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 203, NO. 4, (635-636), Online publication date: 1-Apr-2020. Volume 203Issue 4April 2020Page: 734-742 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsprostate-specific antigentreatment failureprostatic neoplasmsradiofrequency ablationultrasonographyMetricsAuthor Information Philipp M. Huber Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland Department of Urology, Bern and St. Anna Klinik Lucerne, Lucerne, Switzerland Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Naveed Afzal Department of Urology, Dorset County Hospital NHS Trust, Dorset, United Kingdom More articles by this author Manit Arya Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom More articles by this author Silvan Boxler Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland More articles by this author Tim Dudderidge Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom More articles by this author Mark Emberton Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author Stephanie Guillaumier Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author Richard G. Hindley Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, United Kingdom Financial interest and/or other relationship with Sonacare US. More articles by this author Feargus Hosking-Jervis Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Lucas Leemann Department of Political Science, University of Zurich, Zürich, Switzerland More articles by this author Henry Lewi Springfield Hospital, Chelmsford, United Kingdom More articles by this author Neil McCartan Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author Caroline M. Moore Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom More articles by this author Raj Nigam Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, United Kingdom More articles by this author Chris Odgen Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom More articles by this author Raj Persad Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom More articles by this author George N. Thalmann Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland More articles by this author Jaspal Virdi Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom More articles by this author Mathias Winkler Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Hashim U. Ahmed Division of Surgery and Interventional Sciences, University College London, London, United Kingdom Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom †Correspondence: Imperial College London, Fulham Palace Rd., London, W6 8RF, United Kingdom ( E-mail Address: [email protected] More articles by this author Expand All Supported by the United Kingdom MRC (Medical Research Council) (HUA) and an unrestricted grant from Sonacare (ME and HUA). Advertisement PDF downloadLoading ...
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