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.

• Authors: Christopher J DiBlasio, Ithaar H Derweesh, John B Malcolm, Michael M Maddox, Michael A Aleman, Robert W Wake
• Journal: International braz j urol : official journal of the Brazilian Society of Urology (Int Braz J Urol) 2008 Jul-Aug Vol. 34 Issue 4 Pg. 443-50 ISSN: 1677-6119 [Electronic] Brazil
• PMID: 18778495 (Publication Type: Journal Article)

Chemical References

• Prostate-Specific Antigen

Topics

• Aged
• Aged, 80 and over
• Cohort Studies
• Cryosurgery (adverse effects)
• Erectile Dysfunction (etiology)
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Penile Erection
• Prostate-Specific Antigen
• Prostatic Neoplasms (surgery)
• Retrospective Studies
• Urination Disorders (etiology)