title: Impact of prostate gland volume on cryoablation prostate-specific antigen outcomes.
abstract: OBJECTIVE
  To assess the impact of prostate volume on prostate-specific antigen (PSA) outcomes after primary whole-gland cryoablation.
  
  
  METHODS
  The prognostic value of prostate volume, PSA at diagnosis, Gleason score, risk category, and clinical stage for favorable initial postcryoablation PSA (<0.6 ng/mL) was assessed in a risk-stratified cohort from the Cryo On Line Data (COLD) Registry. The cohort was substratified by prostate volume, <50 cm(3) (n = 2316) and ≥50 cm(3) (n = 369). The incidence of incontinence, rectal fistula, and potency is reported.
  
  
  RESULTS
  Prostate volume was not a statistically significant predictor of favorable PSA outcome (P = .153, univariate, 0.101, multivariate). Favorable PSA (<0.6 ng/mL) occurred in 80% (<50 cm(3)) and 83% (≥50 cm(3)) of patients, respectively. PSA at diagnosis (P = .02) and Gleason score (P < .0001) by univariate analysis, and clinical stage (P < .0001) and risk category (P < .0001) by multivariate analysis predicted for favorable PSA outcomes. Initial postcryoablation PSA ≥0.6 ng/mL was associated with significantly worse 24-month biochemical progression. No statistical difference in incidence of incontinence (3.3% vs 2.1%) retention (1.1% vs 2.6%), potency (30.3% vs 32.2%) or fistula (0.6% vs 0.2%) based on prostate volume was identified.
  
  
  CONCLUSIONS
  Prostate volume does not predict for favorable PSA after cryoablation. PSA at diagnosis (P = .02) and Gleason score (P < .0001) (univariate) and risk category (P < .0001) and clinical stage (P < 0.0001) (multivariate) are prognostic for favorable PSA outcomes. Morbidity was similar between groups.
authors.affiliation: Department of Regional Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. Levyd3@ccf.org
authors.forename: David A
authors.initials: DA
authors.lastname: Levy
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D003452:Cryosurgery; D018450:Disease Progression; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen