MP73-01 DOES MRI OR PSA PREDICT BIOPSY OUTCOME AFTER FOCAL CRYOTHERAPY FOR PROSTATE CANCER?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP73-01 DOES MRI OR PSA PREDICT BIOPSY OUTCOME AFTER FOCAL CRYOTHERAPY FOR PROSTATE CANCER? Wayne Brisbane, Mamdouh Aker, Lorna Kwan, Samantha Gonzalez, Alan Priester, Adam Kinnaird, Merdie Delfin, Ely Felker, Anthony Sisk, and David Kupperman Wayne BrisbaneWayne Brisbane More articles by this author , Mamdouh AkerMamdouh Aker More articles by this author , Lorna KwanLorna Kwan More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Alan PriesterAlan Priester More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , Ely FelkerEly Felker More articles by this author , Anthony SiskAnthony Sisk More articles by this author , and David KuppermanDavid Kupperman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to determine the value of MRI and serum PSA levels in prediction of targeted biopsy results after partial gland ablation (PGA) of intermediate-risk prostate cancer (PCa) using cryotherapy (CRYO). METHODS: In a prospective, observational trial (NCT03503643), 143 men with unilateral PCa (all >GG2) were enrolled. PSA and MRI-guided biopsy (MRGB) was performed before and after PGA with CRYO. CRYO treatment was a 2-cycle freeze of the affected prostate part using argon gas delivered via transperineal needles under image guidance. Participants underwent MRI/US fusion biopsy at baseline to determine eligibility; at 6 months to determine technical success; and at 18 months. Fusion MRGB in follow-up at 6 and 18 months employed tracking technology (JAMA Open: 31509206). Successful ablation=absence of PCa >GG2 on MRGB. Effects on urinary and sexual function were studied via EPIC-CP. RESULTS: 95% of enrollees (136/143) completed f/u MRGB at 6 mo; 103 had a successful ablation (74%). Of the 103, 71 then had 18-mo f/u MRGB; success rate at 18 mo was 46/71 (65%); among 25 failures at 18 months, PCa was ipsilateral in 8, contralateral in 12, and bilateral in 5. Baseline MRI lesions (PIRADS >3) disappeared post-CRYO in 96/130 men (74%); PCa was found in 22/96 (23%) with no lesion and 11/34 (32%) with lesions (p=NS). In a mult-variate analysis, lesion diameter was the only parameter related to biopsy outcome. PSA levels were similar (p=NS) before and after CRYO in successful and failed treatments (FIGURE), as was PSA density. After CRYO, urinary function changed but little, or improved; overall sexual function decreased in 53/143 (39%), but only 10/143 men reported a severe decrement (>6 point decline). CONCLUSIONS: In the near to intermediate term, PGA with cryotherapy is a safe and moderately effective treatment of intermediate-risk PCa, when outcome is judged by MRGB. Neither PSA nor MRI, at baseline or during follow-up, appear reliable as indicators of post-treatment tissue findings. We postulate the treatment per se alters prostate anatomy and physiology in a manner that obscures a relationship between either test and pathological outcome. Source of Funding: This work was supported in part by the National Cancer Institute (R01CA195505), UCLA CTSI (UL1TR000124), the Jean Perkins Foundation, the Kent Kresa Family Foundation, and the Steven C. Gordon Family Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1034 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wayne Brisbane More articles by this author Mamdouh Aker More articles by this author Lorna Kwan More articles by this author Samantha Gonzalez More articles by this author Alan Priester More articles by this author Adam Kinnaird More articles by this author Merdie Delfin More articles by this author Ely Felker More articles by this author Anthony Sisk More articles by this author David Kupperman More articles by this author Expand All Advertisement PDF downloadLoading ...