title: Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen.
abstract: Salvage prostate cryoablation is an effective treatment for patients with localized prostate cancer relapse following primary radiotherapy. The postsalvage prostate-specific antigen (PSA) nadir that best predicts long-term biochemical progression-free survival (bPFS) is not yet defined. We sought to determine what nadir PSA best predicted success following salvage whole-gland cryoablation.
  
  
  
  We retrospectively reviewed a cohort of 486 hormone-naive patients who underwent salvage whole-gland cryoablation from the Cryo On-Line Database (COLD). Studied variables were age, race, initial PSA, presalvage prostate-specific antigen (psPSA), initial Gleason score, Gleason score at presalvage biopsy, clinical stage, and follow-up PSA values. Kaplan-Meier (KM) analysis was used to calculate 5-year bPFS using the Phoenix criteria. Hazard ratio and relative risk were also analyzed. Differences among the KM estimates, at 5 years, were calculated using the log-rank test.
  
  
  
  Using group thresholds, KM analysis identified nadir PSA less than or greater than 0.4 ng/mL as the nadir PSA threshold, with the greatest difference in bPFS. The KM estimated 5-year bPFS was 75.5% and 22.1% for nadir PSA <0.4 and ≥0.4 ng/mL, respectively. Stratified by psPSA, the KM estimated 5-year bPFS comparing patients with PSA nadir <0.4 vs ≥0.4 ng/mL was 78.5% and 17.9% (p < 0.0001) for psPSA <4 ng/mL, 77.1% and 15.7% (p < 0.0001) for psPSA 4-10 ng/mL, and 77.8% and 16.8% (p < 0.0001) for psPSA >10 ng/mL, respectively.
  
  
  
  The best objective indicator of biochemical success following whole-gland salvage cryoablation of the prostate is PSA nadir <0.4 ng/mL.
authors.affiliation: 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Evan
authors.initials: E
authors.lastname: Kovac
authors.affiliation: 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.|2 Urology Department, Medical School, Cairo University , Giza, Egypt .
authors.forename: Ahmed
authors.initials: A
authors.lastname: ElShafei
authors.affiliation: 3 Division of Urology, Department of Surgery, Duke University Medical Center , Durham, North Carolina.
authors.forename: Kae Jack
authors.initials: KJ
authors.lastname: Tay
authors.affiliation: 3 Division of Urology, Department of Surgery, Duke University Medical Center , Durham, North Carolina.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mendez
authors.affiliation: 3 Division of Urology, Department of Surgery, Duke University Medical Center , Durham, North Carolina.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.affiliation: 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003452:Cryosurgery / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen