- Published date :
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Mar 1, 2010
MedWire News: Low disease burden prior to primary prostate cryoablation is highly prognostic for having an initial post-cryoablation PSA below 0.6 ng/ml, researchers report.
David Levy (Cleveland Clinic Foundation, Ohio, USA) and colleagues reviewed the medical charts from 122 cryoablation patients treated at Cleveland Clinic from 2004 through May 2009.
They studied the prognostic value of age, race, PSA at diagnosis, Gleason score, risk category, prostate gland volume, clinical T stage, number of cores positive, percent of core involved with disease, ratios of number of cores positive to total cores biopsied and number of cores positive to prostate gland volume, and initial PSA results.
In all, 16.4% of patients had postoperative PSA levels of 0.6 ng/ml or more. On multivariate analysis, number of cores positive, maximum percent core positive, and ratio of number of positive cores to prostate gland volume (cm3) were prognostic for postoperative PSA levels of less than 0.6 ng/ml based on an initial PSA of less than 0.6 ng/ml.
Further analysis of the data suggested identifiable thresholds at or below which favorable PSA outcomes were more likely. The threshold values were number of cores positive (4), maximum percent core involved (30%), and ratio of number of cores positive to prostate gland volume (cm3) (0.097).
Levy et al comment in the journal Urology: “The reference end point in the current study, a post-cryoablation PSA of <0.6 ng/ml, is not intended to represent a measure of treatment success. This value is an evidence-based component of treatment outcomes that will be incorporated into a developing definition of treatment success that will evolve from ongoing and future collaborative studies of primary whole gland cryoablation populations.”
They note that diagnostic PSA, Gleason score, and clinical stage “failed to yield any statistically significant prognostic information with respect to initial post-cryoablation PSA level in our institutional study.”
The researchers conclude that “the relative disease burden in the gland as identified by biopsy data are the most significant predictor of cryosurgical outcomes identified to date.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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