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Two Year Functional Outcomes Stratified According to Baseline Erectile Function Following Partial Gland Cryo-Ablation

Published:October 19, 2022DOI:https://doi.org/10.1016/j.urology.2022.10.003

      Abstract

      OBJECTIVE

      To critically evaluate time dependent sexual function following primary partial gland cryo-ablation (PGCA) stratified according to baseline erectile function.

      METHODS

      Between March 2017 and March 2022, all men undergoing primary PGCA by 2 surgeons were enrolled in an IRB approved outcomes registry. All subjects with PIRADS 2-5 lesion concordant with unilateral GGG 1-3 disease, no gross extra-prostatic extension on mpMRI, GGG >1 contralateral to the ROI, or distal apical disease on mpMRI were enrolled. Patients completed the Sexual Health Inventory for Men (SHIM) scale at baseline, 6, and 24 months. Men were stratified by baseline erectile function. Men with SHIM Score < 8 were excluded. Ability to sustain erection (aka “potency”) was defined as a score of 3 or greater on question 2 of the SHIM index. Median SHIM scores and the proportion of men reporting “potency” at baseline, 6, and 24 months was recorded with comparisons between each timepoint. A univariate analysis was used to determine if clinical factors were associated with loss of “potency” at 24 months.

      RESULTS

      106 men met the inclusion criteria. There was a statistically significant decrease in the mean SHIM scores for the entire cohort between baseline to 6 months and baseline to 24 months. SHIM scores increased significantly for the total cohort between 6 and 24 months. “Potency” was preserved in 70% at 24 months.

      CONCLUSION

      Those patients most likely to exhibit a decrease in sexual function have moderate ED at baseline. Only baseline ED was shown to predict preservation of “potency”.
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      References

        • Sanda MG
        • Dunn RL
        • Michalski J
        • et al.
        Quality of life and satisfaction with outcome among prostate-cancer survivors.
        N Engl J Med. 2008; 358: 1250-1261
        • Hoffman KE
        • Penson DF
        • Zhao Z
        • et al.
        Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.
        JAMA. 2020; 323: 149-163
        • Clark JA
        • Bokhour BG
        • Inui TS
        • Silliman RA
        • Talcott JA.
        Measuring patients' perceptions of the outcomes of treatment for early prostate cancer.
        Med Care. 2003; 41: 923-936
        • Wallis CJD
        • Zhao Z
        • Huang LC
        • et al.
        Association of treatment modality, functional outcomes, and baseline characteristics with treatment-related regret among men with localized prostate cancer.
        JAMA Oncol. 2022; 8: 50-59
        • Shah TT
        • Reddy D
        • Peters M
        • et al.
        Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study.
        Prostate Cancer Prostatic Dis. 2021; 24: 567-574
        • Valerio M
        • Cerantola Y
        • Eggener SE
        • et al.
        New and established technology in focal ablation of the prostate: a systematic review.
        Eur Urol. 2017; 71: 17-34
        • Lepor H
        • Llukani E
        • Sperling D
        • Futterer JJ.
        Complications, recovery, and early functional outcomes and oncologic control following in-bore focal laser ablation of prostate cancer.
        Eur Urol. 2015; 68: 924-926
        • Wysock JS
        • Becher E
        • Gogaj R
        • Velazquez N
        • Lepor H.
        Early oncological control following partial gland cryo-ablation: a prospective experience specifying reflex MRI guided biopsy of the ablation zone.
        Prostate Cancer Prostatic Dis. 2021; 24: 114-119
        • Chao B
        • Lepor H.
        5-year outcomes following focal laser ablation of prostate cancer.
        Urology. 2021; 155: 124-129
        • Thakker S
        • Wysock J
        • Matulewicz R
        • Gogaj R
        • Lepor H.
        Early functional outcomes following partial gland cryo-ablation.
        Can J Urol. 2022; 29: 11128-11135
        • Mendhiratta N
        • Rosenkrantz AB
        • Meng X
        • et al.
        Magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in a consecutive cohort of men with no previous biopsy: reduction of over detection through improved risk stratification.
        J Urol. 2015; 194: 1601-1606
        • Becher E
        • Lepor H.
        Oncological control following partial gland ablation for intermediate-risk prostate cancer.
        Urol Oncol. 2020; 38: 671-677
        • Le Nobin J
        • Rosenkrantz AB
        • Villers A
        • et al.
        Image guided focal therapy for magnetic resonance imaging visible prostate cancer: defining a 3-dimensional treatment margin based on magnetic resonance imaging histology co-registration analysis.
        J Urol. 2015; 194: 364-370
        • Cappelleri JC
        • Rosen RC.
        The sexual health inventory for Men (SHIM): a 5-year review of research and clinical experience.
        Int J Impot Res. 2005; 17: 307-319
        • Bahn D
        • de Castro Abreu AL
        • Gill IS
        • et al.
        Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years.
        Eur Urol. 2012; 62: 55-63
        • Rosner B
        • Glynn RJ
        • Lee ML.
        The Wilcoxon signed rank test for paired comparisons of clustered data.
        Biometrics. 2006; 62: 185-192
      1. Stata Statistical Software: Release 17 [computer program].
        StataCorp LLC, College Station, TX2021
        • Bill-Axelson A
        • Holmberg L
        • Garmo H
        • et al.
        Radical prostatectomy or watchful waiting in prostate cancer - 29-year follow-up.
        N Engl J Med. 2018; 379: 2319-2329
        • Epstein JI
        • Zelefsky MJ
        • Sjoberg DD
        • et al.
        A contemporary prostate cancer grading system: a validated alternative to the gleason score.
        Eur Urol. 2016; 69: 428-435
        • Darwish OM
        • Raj GV.
        Management of biochemical recurrence after primary localized therapy for prostate cancer.
        Front Oncol. 2012; 2: 48
        • Haglind E
        • Carlsson S
        • Stranne J
        • et al.
        Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial.
        Eur Urol. 2015; 68: 216-225
        • Capogrosso P
        • Vertosick EA
        • Benfante NE
        • et al.
        Are we improving erectile function recovery after radical prostatectomy? Analysis of patients treated over the last decade.
        Eur Urol. 2019; 75: 221-228
        • Lee T
        • Fenstermaker M
        • Taksler GB
        • Lepor H.
        Long-term satisfaction after open radical prostatectomy.
        Urology. 2015; 85: 1130-1136
        • Christie DR
        • Sharpley CF
        • Bitsika V.
        Why do patients regret their prostate cancer treatment? A systematic review of regret after treatment for localized prostate cancer.
        Psychooncology. 2015; 24: 1002-1011
        • Marien T
        • Sankin A
        • Lepor H.
        Factors predicting preservation of erectile function in men undergoing open radical retropubic prostatectomy.
        J Urol. 2009; 181: 1817-1822
        • Tan WP
        • Chang A
        • Sze C
        • Polascik TJ.
        Oncological and functional outcomes of patients undergoing individualized partial gland cryoablation of the prostate: a single-institution experience.
        J Endourol. 2021; 35: 1290-1299
        • Oishi M
        • Gill IS
        • Tafuri A
        • et al.
        Hemigland cryoablation of localized low, intermediate and high risk prostate cancer: oncologic and functional outcomes at 5 years.
        J Urol. 2019; 202: 1188-1198
        • Padma-Nathan H
        • McCullough AR
        • Levine LA
        • et al.
        Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy.
        Int J Impot Res. 2008; 20: 479-486
        • McCullough A.
        Penile change following radical prostatectomy: size, smooth muscle atrophy, and curve.
        Curr Urol Rep. 2008; 9: 492-499
        • Lee J
        • Hersey K
        • Lee CT
        • Fleshner N.
        Climacturia following radical prostatectomy: prevalence and risk factors.
        J Urol. 2006; 176: 2562-2565