Philipp M Huber1,2,3,4, Naveed Afzal5, Manit Arya3,4,6, Silvan Boxler1, Tim Dudderidge7, Mark Emberton8,3, Stephanie Guillaumier8,3, Richard G Hindley9, Feargus Hosking-Jervis10,4, Lucas Leemann11, Henry Lewi12, Neil McCartan8,3, Caroline M Moore8,3, Raj Nigam13, Chris Odgen14, Raj Persad15, George N Thalmann1, Jaspal Virdi6, Mathias Winkler4, Hashim U Ahmed8,10,4. 1. Department of Urology, University Hospital Inselspital Berne, Bern, Switzerland. 2. Department of Urology, Bern and St. Anna Klinik Lucerne, Lucerne, Switzerland. 3. Department of Urology, University College London Hospital, NHS Foundation Trust, London, United Kingdom. 4. Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. 5. Department of Urology, Dorset County Hospital NHS Trust, Dorset, United Kingdom. 6. Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom. 7. Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom. 8. Division of Surgery and Interventional Sciences, University College London, London, United Kingdom. 9. Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, United Kingdom. 10. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom. 11. Department of Political Science, University of Zurich, Zürich, Switzerland. 12. Springfield Hospital, Chelmsford, United Kingdom. 13. Department of Urology, Royal County Surrey Hospital NHS Trust, Guildford, United Kingdom. 14. Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom. 15. Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
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.
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.
Authors: Antony Pellegrino; Giuseppe O Cirulli; Elio Mazzone; Francesco Barletta; Simone Scuderi; Mario de Angelis; Giuseppe Rosiello; Giorgio Gandaglia; Francesco Montorsi; Alberto Briganti; Armando Stabile Journal: Ann Transl Med Date: 2022-07
Authors: Mark Paxton; Eitan Barbalat; Nathan Perlis; Ravi J Menezes; Mark Gertner; David Dragas; Masoom A Haider; Antonio Finelli; John Trachtenberg; Sangeet Ghai Journal: Br J Radiol Date: 2021-07-29 Impact factor: 3.039
Authors: Arnas Bakavicius; Giancarlo Marra; Petr Macek; Cary Robertson; Andre L Abreu; Arvin K George; Bernard Malavaud; Patrick Coloby; Pascal Rischmann; Marco Moschini; Ardeshir R Rastinehad; Abhinav Sidana; Armando Stabile; Rafael Tourinho-Barbosa; Jean de la Rosette; Hashim Ahmed; Thomas Polascik; Xavier Cathelineau; Rafael Sanchez-Salas Journal: Int Braz J Urol Date: 2022 Mar-Apr Impact factor: 1.541