Bowel, Urinary, and Sexual Function in Patients with Low to Intermediate Risk Prostate Cancer on Active Surveillance and Primary Focal Cryotherapy

Abstract

Objectives: Both active surveillance (AS) and primary focal cryotherapy (PFC) are considered suitable approaches for men with low to intermediate risk prostate cancer (PCa). We aim to identify any differences in bowel, urinary, and sexual function that may exist between patients on AS and those who have undergone PFC. Methods:A retrospective review of the 1,230 patients in the IRB-approved Prostate Cancer Database at NYU Langone Hospital-Long Island was performed. 320 of the patients were either on AS or had received PFC at time of review. Exclusion criteria included incomplete questionnaires and additional salvage therapy following PFC. Data from the 179 remaining patients were reviewed for demographics, treatment (AS vs. PFC), prostate-specific antigen (PSA) levels at time of treatment, Gleason scores and grade groups, time to clinical follow-up, and responses to both the Expanded Prostate Cancer Index Composite (EPIC) and the International Index of Erectile Function (IIEF) questionnaires. Descriptive and comparative statistics were used to compare survey outcomes by treatment method.Results: Of the 179 patients with low to intermediate risk prostate cancer, 118 (65.9%) were on AS and 61 (34.1%) received PFC. The two groups varied slightly in pre-treatment Gleason scores and grade groups, with higher-risk patients in the PFC group (p < 0.001). There was no difference in median age (68 vs. 71 years, p = 0.107) or the use of phosphodiesterase-5 inhibitors such as sildenafil or tadalafil (24% vs. 30%, p = 0.425) between the AS and PFC groups at the time of survey completion. The median time from start date of AS or date of PFC to date of survey completion was 38 months and 43 months, respectively (p = 0.586). There was no difference between the two groups in either bowel or urinary function (p = 0.947 and p = 0.278, respectively). The PFC group had higher rates of use of both alpha-blockers and 5-α-reductase inhibitors (p < 0.001 for both). Overall subjective analysis of sexual function was worse among the PFC group (p < 0.001). 20.3% of patients on AS and 27.9% in the PFC group denied any sexual stimulation over four weeks prior to survey completion. The differences in rates of ejaculation and sensation of orgasm with sexual stimulation between the two groups were not significant (p = 0.061 and p = 0.351, respectively). The difference in satisfaction with overall sex life between the two groups was also not significant (p = 0.086).Conclusions: PFC for low to intermediate risk prostate cancer does not impair bowel or urinary function to a significant degree when compared to AS. Though it impairs subjective analysis of overall sexual function, it does not significantly alter rates of ejaculation or sensation of orgasm, or satisfaction with one's sex life.