Head to head comparison of ASTRO, Phoenix and Stuttgart criteria in patients treated with High Intensity Focused Ultrasound for primary prostate cancer
Introduction & Objective:
There is not a consensus regarding the prognostic efficacy of different criteria to define treatment failure after High Intensity Focused Ultrasound (HIFU) for prostate cancer (PCa). In this study we evaluated the prognostic efficacy of commonly used prognosticator according to ASTRO, Phoenix and Stuttgart criteria.
Materials and Methods:
Baseline, perioperative and oncologic outcomes of 251 consecutive patients treated with HIFU for primary PCa between 2004 and 2014 were prospectively collected into an institutional database.
Treatment failure was coded according to available criteria described above. Univariable and multivariable Cox analyses were performed to test the efficacy of known prognostic factors in predicting outcomes according to the 3 criteria.
One-yr recurrence free survival rates were 80.7%, 64.1% and 37.3% according to Phoenix, ASTRO and Stuttgart criteria, respectively, while 5-recurrence free survival rates were 70.3%, 46.1% and 28.5%, respectively (Figure 1).
At univariable Cox analysis baseline PSA, cT stage and biopsy Gleason score were significant predictors of recurrence according to Phoenix criteria (all p ≤0.003), while none of these variables was predictive of recurrence neither according to ASTRO nor to Stuttgart criteria (Table 1).
At multivariable Cox analysis, biopsy Gleason score and cT stage were independent predictors of recurrence according to Phoenix criteria ( p=0.049 [HR 1.67, 95% CI 1.01-2.789] and p=0.005 [HR 1.38, 95% CI 1.1-1.73]).
Established prognosticators of PCa recurrence-free survival do not accurately predict oncologic outcomes according to ASTRO or Stuttgart criteria after HIFU for PCa. In the preoperative patients counseling the only criteria that provide an accurate prediction of recurrence free survival based on commonly used clinical parameters are Phoenix criteria.