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C09: The assessment of PSA concentration dynamics in prostate cancer patients treated with “radical-HIFU” in own material – preliminary findings
C09: The assessment of PSA concentration dynamics in prostate cancer patients treated with “radical-HIFU” in own material - preliminary findings Filipek M.1, Czarniecki S.1, Lewicki A.2 1
Ameds Medical Center, Dept. of Urology, Grodzisk Mazowiecki, Poland, 2Miedzyleski Specialist Hospital, Dept. of Urology, Warsaw, Poland INTRODUCTION & OBJECTIVES: High Intensity Focused Ultrasound (HIFU) is a minimally invasive treatment modality for prostate cancer. Over the past 17 years over 40,000 HIFU procedures have been performed worldwide. PSA concentration ranges which would be unequivocally accepted to predict success or failure of therapy are still lacking. The purpose of this paper is to present the dynamics of PSA concentration levels in patients following “radical-HIFU” (TURP+Total Prostate HIFU) over the first year of follow-up, as well as to assess the influence of prostate volume and apical to lower limit of treatment distance (A-L) on this parameter. MATERIAL & METHODS: In our centre 104 HIFU procedures were performed over the years 20112014. A retrospective analysis was performed on a group of 32 patients, aged 55-83 years, fulfilling the following criteria: T1-2M0N0, PSA <18ng/ml, Gleason ≤7, combined “radical-HIFU” therapy. Excluded from the analysis were patients: treated due to local relapse following previous radical treatment, Gleason >7 upon qualification, with an observation time <6 months, and those using PSA modifying pharmacotherapy. The following parameters were analysed: PSA concentration prior to prostate biopsy (PSAb), prior to HIFU (PSAh), at 3, 6, 9, 12 months after radical-HIFU, TRUS measured prostate volume at biopsy (Pvb) and at HIFU (Pvh), and A-L. RESULTS: Mean follow-up time was 8.8 months (6-12). Nadir PSA was reached at a mean of 4.1 months (3-9). The median nadir PSA was 0.08 ng/ml (0.002-4.62). The median PSA concentration at 3, 6, 9,12 months, respectively, were 0.09 ng/ml (0.002-7.8), 0.16 ng/ml (0.004-4.76), 0.06 ng/ml (0.002-5.93), 0.18 ng/ml (0.002-5.09). Mean PSAb was 7.84 ng/ml (3.19-17.62), and mean PSAh was 7.28 ng/ml (1.16-13.95). Mean Pvb was 37.85 cm3 (18-60.6), and mean Pvh was 21.29 ng/ml (13.5132.81). In the Pvh ranges 13-18 cm3 (n=6), 18-23 cm3 (n=16), 23-28 cm3 (n=7), 28-33 cm3 (n=3) the median nadir PSA concentration was, respectively, 0.009 ng/ml, 0.08 ng/ml, 0.08 ng/ml, 0.19 ng/ml. The mean A-L distance was 4,72 mm (3.23-6.01). In the A-L ranges 3-4 mm (n=3), 4-5 mm (n=16), 5-6 mm (n=12), the median nadir PSA was, respectively, 0.01, 0.08, 0.14 ng/ml. CONCLUSIONS: 1. The nadir PSA concentration was reached at a mean of 4.1 months. The median nadir was 0.08 ng/ml (0.002-4.62). 2. The lowest nadir PSA was observed in the range Pvh 28 cm3 correlated to a significantly higher median nadir PSA concentration. 3. The A-L distance influences the nadir PSA concentration. As the A-L distance increases, higher nadir PSA values are observed. Eur Urol Suppl 2014; 13(6) e1212
Ameds Medical Center, Dept. of Urology, Grodzisk Mazowiecki, Poland, 2Miedzyleski Specialist Hospital, Dept. of Urology, Warsaw, Poland INTRODUCTION & OBJECTIVES: High Intensity Focused Ultrasound (HIFU) is a minimally invasive treatment modality for prostate cancer. Over the past 17 years over 40,000 HIFU procedures have been performed worldwide. PSA concentration ranges which would be unequivocally accepted to predict success or failure of therapy are still lacking. The purpose of this paper is to present the dynamics of PSA concentration levels in patients following “radical-HIFU” (TURP+Total Prostate HIFU) over the first year of follow-up, as well as to assess the influence of prostate volume and apical to lower limit of treatment distance (A-L) on this parameter. MATERIAL & METHODS: In our centre 104 HIFU procedures were performed over the years 20112014. A retrospective analysis was performed on a group of 32 patients, aged 55-83 years, fulfilling the following criteria: T1-2M0N0, PSA <18ng/ml, Gleason ≤7, combined “radical-HIFU” therapy. Excluded from the analysis were patients: treated due to local relapse following previous radical treatment, Gleason >7 upon qualification, with an observation time <6 months, and those using PSA modifying pharmacotherapy. The following parameters were analysed: PSA concentration prior to prostate biopsy (PSAb), prior to HIFU (PSAh), at 3, 6, 9, 12 months after radical-HIFU, TRUS measured prostate volume at biopsy (Pvb) and at HIFU (Pvh), and A-L. RESULTS: Mean follow-up time was 8.8 months (6-12). Nadir PSA was reached at a mean of 4.1 months (3-9). The median nadir PSA was 0.08 ng/ml (0.002-4.62). The median PSA concentration at 3, 6, 9,12 months, respectively, were 0.09 ng/ml (0.002-7.8), 0.16 ng/ml (0.004-4.76), 0.06 ng/ml (0.002-5.93), 0.18 ng/ml (0.002-5.09). Mean PSAb was 7.84 ng/ml (3.19-17.62), and mean PSAh was 7.28 ng/ml (1.16-13.95). Mean Pvb was 37.85 cm3 (18-60.6), and mean Pvh was 21.29 ng/ml (13.5132.81). In the Pvh ranges 13-18 cm3 (n=6), 18-23 cm3 (n=16), 23-28 cm3 (n=7), 28-33 cm3 (n=3) the median nadir PSA concentration was, respectively, 0.009 ng/ml, 0.08 ng/ml, 0.08 ng/ml, 0.19 ng/ml. The mean A-L distance was 4,72 mm (3.23-6.01). In the A-L ranges 3-4 mm (n=3), 4-5 mm (n=16), 5-6 mm (n=12), the median nadir PSA was, respectively, 0.01, 0.08, 0.14 ng/ml. CONCLUSIONS: 1. The nadir PSA concentration was reached at a mean of 4.1 months. The median nadir was 0.08 ng/ml (0.002-4.62). 2. The lowest nadir PSA was observed in the range Pvh 28 cm3 correlated to a significantly higher median nadir PSA concentration. 3. The A-L distance influences the nadir PSA concentration. As the A-L distance increases, higher nadir PSA values are observed. Eur Urol Suppl 2014; 13(6) e1212