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Khirurgii

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Year 2016 Vol. 24 No 5

UROLOGY

R.N. FOMKIN, T.V. SHATYLKO

PSA NADIR AS A BASIC PREDICTOR OF LOCALIZED PROSTATE CANCER RECURRENCE AFTER HIFU-ABLATION

SBEE HPE "Saratov State Medical University named after V.I. Razumovsky",
Research Institute of Fundamental and Clinical Uronephrology,
Saratov.
The Russian Federation

Objectives. To assess whether prostate-specific antigen (PSA) nadir is an independent predictor of recurrence and disease-free survival after high-intensity focused ultrasound (HIFU) in localized prostate cancer, using ASTRO new criteria.
Methods. Clinical cases of patients (n=103) after HIFU-ablation (Ablatherm, France) with the localized prostate cancer without previous hormonal therapy were analyzed, retrospectively. Patients were observed regularly at control visits every 3 months. Recurrence was defined by the revised ASTRO criteria (PSA 2 ng/ml or more above the nadir, positive biopsy, appointment of rescue therapy). The patients were divided into three groups depending on the level of PSA nadir: Group I – 0,2 ng/ml or less; group II, – 0,21-1 ng/ml; Group III – more than 1 ng/ml. Relapse-free survival was calculated using the method of mortality tables. The log rank test was used to compare the constructed Kaplan-Meier curves.
Results. Median follow-up was 4,9 (3-8,6) years. The average time to reach PSA nadir was 6,4±5,1 months. PSA nadir of 0,2 ng/ml or less was achieved in 64% of patients, 0,21-1 ng/ml – 22,3% of the patients more than 1 ng/ml – 13,6%. The recurrence rate was 4,5%, 30,4% and 100%, respectively (p<0,001) in those groups. Five-year actuarial disease-free survival in those groups was 95%, 55% and 0%, respectively (p<0,001).
Conclusion. The level of PSA nadir after HIFU-ablation correlates with a high degree of statistical significance with the probability of recurrence and disease-free survival, which can be applied in a real clinical practice. Promising oncological result may be expected in case of reaching PSA nadir 0,2 ng/mL or less.

Keywords: HIFU, PSA, biochemical recurrence, nadir, predictor of recurrence, mortality
p. 489-496 of the original issue
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Address for correspondence:
410054, the Russian Federation,
Saratov, Bolshaya Sadovaya st., 137/7.
Clinical Hospital named after SR Mirotvortseva SSMU,
department of urology,
Research Institute for Fundamental and Clinical Uronephrology.
Tel: +7 927 123-38-01
E-mail: rnfomkin@mail.ru
Fomkin Roman Nikolaevich
Information about the authors:
Fomkin R.N. PhD, Ass. Professor of department of urology, SBEE HPE "Saratov State Medical University named after V.I.Razumovsky", Senior Researcher, Research Institute of Fundamental and Clinical Uronephrology.
Shatylko T.V. Post-graduate student, SBEE HPE "Saratov State Medical University named after V.I.Razumovsky", Research Institute of Fundamental and Clinical Uronephrology.
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