Method to determine the nadir PSA following partial gland ablation
Abstract Objectives The objective of this study is to propose a novel method of determining the nadir PSA (nPSA) for men with prostate cancer treated by partial gland ablation (PGA). Materials and Methods Two cohorts of men were analyzed to develop a formula for the nPSA in men undergoing PGA. First...
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Wiley
2025-02-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.496 |
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| author | Nelson N. Stone Vassilios Skouteris Rendi Shu Richard G. Stock Ben GL Vanneste |
| author_facet | Nelson N. Stone Vassilios Skouteris Rendi Shu Richard G. Stock Ben GL Vanneste |
| author_sort | Nelson N. Stone |
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| description | Abstract Objectives The objective of this study is to propose a novel method of determining the nadir PSA (nPSA) for men with prostate cancer treated by partial gland ablation (PGA). Materials and Methods Two cohorts of men were analyzed to develop a formula for the nPSA in men undergoing PGA. First, 123 men with a suspicion of prostate cancer underwent transperineal mapping biopsy (TPMB) and found to have benign pathology. Their prostate‐specific antigen (PSA) was compared to the prostate volume using curve estimation regression analysis. Second, the contribution of PSA from an ablated region was determined by using a surrogate of 545 men who had whole‐gland brachytherapy followed by prostate biopsy. Biopsy results were compared to radiation dose (calculated as the biological equivalent dose) levels in men who were free from biochemical failure. The nPSA was then calculated by using the PSA density (PSAD) for the untreated volume plus the PSA from the post‐brachytherapy patients. Results The PSAD with the highest R2 (0.80, p < 0.001) for the 123 men who had TPMB and a negative biopsy was 0.12 ng/mL2. In the brachytherapy patients, five 20 Gy dose groups were analyzed from ≤140 to ≥220 Gy, which demonstrated a progressive decrease in the positive biopsy rate to 1.5% at the highest dose (p = 0.036). PSA was <0.2 ng/mL in 98.2% of these men. If brachytherapy was used for PGA and a dose of ≥ 220 Gy was delivered to the ablation zone, the nPSA could be calculated from the remaining untreated volume as: the [(pretreatment PV)–treated volume] ×0.12 ng/mL2. Conclusion A method for determining the nPSA following PGA using brachytherapy was developed. The formula relies on complete ablation of the treated volume, which resulted in no PSA contribution from that component. Other forms of ablative energy should yield similar results. Further clinical validation of this concept is warranted. |
| format | Article |
| id | doaj-art-c1bf8377836e4d2eb147cd4e4c36b531 |
| institution | DOAJ |
| issn | 2688-4526 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
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| series | BJUI Compass |
| spelling | doaj-art-c1bf8377836e4d2eb147cd4e4c36b5312025-08-20T02:45:52ZengWileyBJUI Compass2688-45262025-02-0162n/an/a10.1002/bco2.496Method to determine the nadir PSA following partial gland ablationNelson N. Stone0Vassilios Skouteris1Rendi Shu2Richard G. Stock3Ben GL Vanneste4Department of Urology The Icahn School of Medicine at Mount Sinai New York New York USABrachytherapy Center Hygeia Hospital Athens GreeceDepartment of Radiation Oncology The Icahn School of Medicine at Mount Sinai New York New York USADepartment of Radiation Oncology The Icahn School of Medicine at Mount Sinai New York New York USADepartment of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction Maastricht University Medical Centre+ Maastricht The NetherlandsAbstract Objectives The objective of this study is to propose a novel method of determining the nadir PSA (nPSA) for men with prostate cancer treated by partial gland ablation (PGA). Materials and Methods Two cohorts of men were analyzed to develop a formula for the nPSA in men undergoing PGA. First, 123 men with a suspicion of prostate cancer underwent transperineal mapping biopsy (TPMB) and found to have benign pathology. Their prostate‐specific antigen (PSA) was compared to the prostate volume using curve estimation regression analysis. Second, the contribution of PSA from an ablated region was determined by using a surrogate of 545 men who had whole‐gland brachytherapy followed by prostate biopsy. Biopsy results were compared to radiation dose (calculated as the biological equivalent dose) levels in men who were free from biochemical failure. The nPSA was then calculated by using the PSA density (PSAD) for the untreated volume plus the PSA from the post‐brachytherapy patients. Results The PSAD with the highest R2 (0.80, p < 0.001) for the 123 men who had TPMB and a negative biopsy was 0.12 ng/mL2. In the brachytherapy patients, five 20 Gy dose groups were analyzed from ≤140 to ≥220 Gy, which demonstrated a progressive decrease in the positive biopsy rate to 1.5% at the highest dose (p = 0.036). PSA was <0.2 ng/mL in 98.2% of these men. If brachytherapy was used for PGA and a dose of ≥ 220 Gy was delivered to the ablation zone, the nPSA could be calculated from the remaining untreated volume as: the [(pretreatment PV)–treated volume] ×0.12 ng/mL2. Conclusion A method for determining the nPSA following PGA using brachytherapy was developed. The formula relies on complete ablation of the treated volume, which resulted in no PSA contribution from that component. Other forms of ablative energy should yield similar results. Further clinical validation of this concept is warranted.https://doi.org/10.1002/bco2.496biochemical failurebiopsyfocal therapynadir PSAprostate cancerradiation dose |
| spellingShingle | Nelson N. Stone Vassilios Skouteris Rendi Shu Richard G. Stock Ben GL Vanneste Method to determine the nadir PSA following partial gland ablation BJUI Compass biochemical failure biopsy focal therapy nadir PSA prostate cancer radiation dose |
| title | Method to determine the nadir PSA following partial gland ablation |
| title_full | Method to determine the nadir PSA following partial gland ablation |
| title_fullStr | Method to determine the nadir PSA following partial gland ablation |
| title_full_unstemmed | Method to determine the nadir PSA following partial gland ablation |
| title_short | Method to determine the nadir PSA following partial gland ablation |
| title_sort | method to determine the nadir psa following partial gland ablation |
| topic | biochemical failure biopsy focal therapy nadir PSA prostate cancer radiation dose |
| url | https://doi.org/10.1002/bco2.496 |
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