Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer

Abstract

Purpose: To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort. Materials and Methods:We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. Results: After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9%) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7%) regained EF of level 1-2 while 1 (2.9%) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7%) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively). Conclusions: Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7%. Further, though erectile dysfunction is common following TCAP, 25.7% of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.

Cryosurgery would be An Effective Option for Clinically Localized Prostate Cancer: A Meta-analysis and Systematic Review

“…Twenty-eight publications20212223242526272829303132333435363738394041424344454647, which had reported availably single-arm results of CS treatment for clinically localized PCa, were screened. Sixteen23242526293031333436384142454647 of these papers had presented outcomes for primary therapy, eight2022272832354043 for salvage therapy following RT, one44 for salvage therapy following primary CS, and three213739 for both therapies.…”

“…Sixteen23242526293031333436384142454647 of these papers had presented outcomes for primary therapy, eight2022272832354043 for salvage therapy following RT, one44 for salvage therapy following primary CS, and three213739 for both therapies. In addition, materials from the Cryo On-Line Data Registry were used in four publications30404546.…”

“…Eighteen studies212224252829323435363738404142434647 showed the outcomes of OS, which revealed a pooled OS of 73–100% at all stages of follow-up (95.9% at year 1, 94.3 at year 3, 73–98.9% OS at year 5, 91–92% at year 8 and 87% at year 10). Fifteen publications212224252729343536373841424347 presented results of 79–100% DSS.…”

“…Fifteen publications212224252729343536373841424347 presented results of 79–100% DSS. Differences between primary and salvage treatment were not clear.…”

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly: a feasibility study with 10 years follow-up

“…The ongoing evolution of imaging is also an exciting and important variable in the development of focal therapy (31). As previously defined for open radical prostatectomy, the trifecta remains the essential group of variables to evaluate for any focal therapy approach (1,32). At the beginning of the HIFU experience, we neither had a definition of risk of recurrence, nor a definition for focal therapy.…”