Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer

Taimur T Shah; Max Peters; Saiful Miah; David Eldred-Evans; Tet Yap; Feargus Hosking-Jervis; Tim Dudderidge; Richard G Hindley; Stuart McCracken; Damian Greene; Raj Nigam; Massimo Valerio; Mathias Winkler; Jaspal Virdi; Manit Arya; Hashim U Ahmed; Suks Minhas

doi:10.1016/j.euf.2019.09.004

Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer

Eur Urol Focus. 2021 Mar;7(2):301-308. doi: 10.1016/j.euf.2019.09.004. Epub 2019 Oct 5.

Authors

Taimur T Shah¹, Max Peters², Saiful Miah³, David Eldred-Evans⁴, Tet Yap⁵, Feargus Hosking-Jervis⁴, Tim Dudderidge⁶, Richard G Hindley⁷, Stuart McCracken⁸, Damian Greene⁹, Raj Nigam¹⁰, Massimo Valerio¹¹, Mathias Winkler¹², Jaspal Virdi¹³, Manit Arya¹⁴, Hashim U Ahmed¹², Suks Minhas¹⁵

Affiliations

¹ Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK. Electronic address: [email protected].
² Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands.
³ Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK.
⁴ Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁵ Department of Urology, Guy's Hospital, Great Maze Pond, London, UK.
⁶ Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
⁷ Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
⁸ Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
⁹ Department of Urology, Sunderland Royal Hospital, Sunderland, UK.
¹⁰ Department of Urology, Royal Surrey County Hospital NHS Trust, UK.
¹¹ Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
¹² Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
¹³ Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
¹⁴ Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
¹⁵ Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.

PMID: 31590961
DOI: 10.1016/j.euf.2019.09.004

Abstract

Background: The oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported.

Objective: To determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function.

Design, setting, and participants: Between October 2013 and November 2016, 58 of 122 men who underwent focal cryotherapy for predominantly anterior clinically significant localised prostate cancer within a prospective registry returned patient-reported outcome measure questionnaires, which included International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-15) questionnaires.

Intervention: Standard cryotherapy procedure using either the SeedNet or the Visual-ICE cryotherapy system.

Outcome measurements and statistical analysis: Primary outcome was return to baseline function of IPSS score and IIEF erectile function (EF) subdomain. Cumulative incidence and Cox-regression analyses were performed.

Results and limitations: Probability of returning to baseline IPSS function was 78% at 12 mo and 87% at both 18 and 24 mo, with recovery seen up to 18 mo. For IIEF (EF domain), the probability of returning to baseline function was 85% at 12 mo and 89% at both 18 and 24 mo, with recovery seen up to 18 mo. Only the preoperative IIEF-EF score was associated with a poor outcome (hazard ratio 0.96, 95% confidence interval 0.93-0.999, p = 0.04). The main limitation was that only half of the patients returned their questionnaires.

Conclusions: In men undergoing primary focal cryotherapy, there is a high degree of preservation of urinary and erectile function with return to baseline function occurring from 3 mo and continuing up to 18 mo after focal cryotherapy.

Patient summary: In men who underwent focal cryotherapy for prostate cancer, approximately nine in 10 returned to their baseline urinary and sexual function. Keeping in mind that level 1 evidence and long-term data are still needed, in men who wish to preserve urinary and sexual function, focal cryotherapy may be considered an alternative treatment option to radical therapy.

Keywords: Clinically significant prostate cancer; Cryotherapy; Focal therapy; International Index of Erectile Function; International Prostate Symptom Score; Patient-reported outcome measure; Sexual function; Urinary function.

MeSH terms

Cryotherapy
Erectile Dysfunction* / therapy
Humans
Male
Prostatic Neoplasms* / surgery

Grants and funding

204998/Z/16/Z/WT_/Wellcome Trust/United Kingdom