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Early Oncological Outcomes of Partial Gland Cryo-ablation by Reflex MRI guided Biopsy of the Ablated Zone.

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Early Oncological Outcomes of Partial Gland Cryo-ablation by Reflex MRI guided Biopsy of the Ablated Zone.

 

Ezequiel Becher 1, James Wysock 1, Rozalba Gogaj 1, Nermarie Velazquez 1, Herbert Lepor 1.

1 Department of Urology, NYU Langone Health, New York, NY.

 

•There is no consensus on how to define oncological control following partial gland ablation (PGA).
•Several consensus statements recommend serial serum prostate specific antigen (PSA) testing, multi parametric magnetic resonance imaging (mpMRI) and prostate biopsy (PBx) without specifying timing of testing.
•The goal of PGA is eradication of clinically significant prostate cancer (csPCa) of the presumed index lesion.
•Therefore, targeted biopsy of the ablation zone (AZ) is the most definitive method for measuring onocological efficacy.
•The optimal timing and technique for post PGA tissue surveillance remains undefined.
•The objective of the present study is to determine the rate of persistent in-field disease following primary partial gland cryo-ablation (PGCA) and whether PSA or mpMRI are reliable predictors of in-field disease persistence.
 
•Between March 2017 and April 2019, subjects meeting eligibility criteria for primary PGCA were enrolled into an IRB approved outcomes registry.
•PSA and mpMRI followed by a PBx (four cores targeting the AZ + six ipsilateral systematic cores) were strongly recommended  six months following intervention.
•Binary logistic regression was employed to calculate odds ratio (OR) of PSA decrease, and suspicious mpMRI effect on cancer persistence.
•The performance of mpMRI for predicting in-field persistence of PCa was evaluated by a receiver operation characteristics curve and area under the curve (AUC).
 
 
•In-field persistence of any cancer was 8.3% and 1.7%, respectively.
•PSA and mpMRI were not reliable predictors of persistent disease at six months, owing to the few cases with in-field disease persistence.
•Our results indicate that six-month mpMRI and biopsy should be discouraged following PGCA performed by experienced ablative surgeons because of the extremely low rate of csPCa. Future studies are In progress to determine the in-field and out-of-field persistence at two years.
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