Nicholas A Faure Walker1, Joseph M Norris2, Taimur T Shah3, Tet Yap4, Paul Cathcart4, Caroline M Moore2, Hashim U Ahmed5, Mark Emberton2, Suks Minhas6. 1. Department of Urology, Guys and St Thomas NHS Foundation Trust, London, UK. Electronic address: Nicholas.faure.walker@gmail.com. 2. Division of Surgery and Interventional Science, University College London, London, UK. 3. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Whittington Hospitals NHS Trust, London, UK. 4. Department of Urology, Guys and St Thomas NHS Foundation Trust, London, UK. 5. Department of Surgery and Cancer, Imperial College, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK. 6. Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
Abstract
OBJECTIVES: To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF. METHOD AND MATERIALS: A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures. RESULTS: Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures. CONCLUSIONS: Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures for comparison. However, FT in general resulted in less effect on EF than WG ablation.
OBJECTIVES: To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF. METHOD AND MATERIALS: A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures. RESULTS: Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures. CONCLUSIONS: Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures for comparison. However, FT in general resulted in less effect on EF than WG ablation.
Authors: Rafael R Tourinho-Barbosa; Lucas Teixeira Batista; Xavier Cathelineau; Javier Sanchez-Macias; Rafael Sanchez-Salas Journal: Turk J Urol Date: 2020-10-09
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Authors: A van Luijtelaar; B M Greenwood; H U Ahmed; A B Barqawi; E Barret; J G R Bomers; M A Brausi; P L Choyke; M R Cooperberg; S Eggener; J F Feller; F Frauscher; A K George; R G Hindley; S F M Jenniskens; L Klotz; G Kovacs; U Lindner; S Loeb; D J Margolis; L S Marks; S May; T D Mcclure; R Montironi; S G Nour; A Oto; T J Polascik; A R Rastinehad; T M De Reyke; J S Reijnen; J J M C H de la Rosette; J P M Sedelaar; D S Sperling; E M Walser; J F Ward; A Villers; S Ghai; J J Fütterer Journal: World J Urol Date: 2019-01-22 Impact factor: 4.226
Authors: Arnas Rakauskas; Giancarlo Marra; Isabel Heidegger; Veeru Kasivisvanathan; Alexander Kretschmer; Fabio Zattoni; Felix Preisser; Derya Tilki; Igor Tsaur; Roderick van den Bergh; Claudia Kesch; Francesco Ceci; Christian Fankhauser; Giorgio Gandaglia; Massimo Valerio Journal: Front Surg Date: 2021-07-12