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

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

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

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.

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

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

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.

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.

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.

European urology focus. 2019 Oct 04 [Epub ahead of print]

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

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: ., Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands., 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., Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Department of Urology, Guy's Hospital, Great Maze Pond, London, UK., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK., Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK., Department of Urology, Sunderland Royal Hospital, Sunderland, UK., Department of Urology, Royal Surrey County Hospital NHS Trust, UK., Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., 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., Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK., 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., Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.