Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious complication of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0±6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P=0.025) and 36 months (8.5 vs 3.5; P=0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87–13.96; P<0.001) and lower EPIC sexual bother (coef, 19.61; CI, 0.32–38.89; P=0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.
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Gonder MJ, Soanes WA, Shulman S . Cryosurgical treatment of the prostate. Invest Urol 1966; 3: 372–378.
Hubosky SG, Fabrizio MD, Schellhammer PF, Barone BB, Tepera CM, Given RW . Single center experience with third-generation cryosurgery for management of organ-confined prostate cancer: critical evaluation of short-term outcomes, complications, and patient quality of life. J Endourol 2007; 21: 1521–1531.
Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M . Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology 2002; 60 (2 Suppl 1): 3–11.
Polascik TJ, Nosnik I, Mayes JM, Mouraviev V . Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third-generation cryotechnology. Urology 2007; 70: 117–121.
Ng CK, Moussa M, Downey DB, Chin JL . Salvage cryoablation of the prostate: followup and analysis of predictive factors for outcome. J Urol 2007; 178 (4 Pt 1): 1253–1257; discussion 1257.
Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000; 283: 354–360.
Litwin MS, Flanders SC, Pasta DJ, Stoddard ML, Lubeck DP, Henning JM . Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 1999; 54: 503–508.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.
Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG . Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 2000; 56: 899–905.
Robinson JW, Moritz S, Fung T . Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys 2002; 54: 1063–1068.
Ellis DS, Manny Jr TB, Rewcastle JC . Cryoablation as primary treatment for localized prostate cancer followed by penile rehabilitation. Urology 2007; 69: 306–310.
Asterling S, Greene DR . Prospective evaluation of sexual function in patients receiving cryosurgery as a primary radical treatment for localized prostate cancer. BJU Int 2009; 103: 788–792.
Robinson JW, Donnelly BJ, Saliken JC, Weber BA, Ernst S, Rewcastle JC . Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery. Urology 2002; 60 (2 Suppl 1): 12–18.
Robinson JW, Donnelly BJ, Coupland K, Siever JE, Saliken JC, Scott C et al. Quality of life 2 years after salvage cryosurgery for the treatment of local recurrence of prostate cancer after radiotherapy. Urol Oncol 2006; 24: 472–486.
Li LY, Lin Z, Yang M, Gao X, Xia TL, Ding T . Comparison of penile size and erectile function after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer: a prospective pilot study. J Sex Med 2010; 7: 3135–3142.
El-Sakka AI, Hassan MU, Selph C, Perinchery G, Dahiya R, Lue TF . Effect of cavernous nerve freezing on protein and gene expression of nitric oxide synthase in the rat penis and pelvic ganglia. J Urol 1998; 160 (6 Pt 1): 2245–2252.
Rambhatla A, Kovanecz I, Ferrini M, Gonzalez-Cadavid NF, Rajfer J . Rationale for phosphodiesterase 5 inhibitor use post-radical prostatectomy: experimental and clinical review. Int J Impot Res 2008; 20: 30–34.
Kovanecz I, Rambhatla A, Ferrini MG, Vernet D, Sanchez S, Rajfer J et al. Chronic daily tadalafil prevents the corporal fibrosis and veno-occlusive dysfunction that occurs after cavernosal nerve resection. BJU Int 2008; 101: 203–210.
Mulhall JP, Muller A, Donohue JF, Mullerad M, Kobylarz K, Paduch DA et al. The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate. J Sex Med 2008; 5: 1126–1136.
Bergman J, Gore JL, Penson DF, Kwan L, Litwin MS . Erectile aid use by men treated for localized prostate cancer. J Urol 2009; 182: 649–654.
Katz D, Bennett NE, Stasi J, Eastham JA, Guillonneau BD, Scardino PT et al. Chronology of erectile function in patients with early functional erections following radical prostatectomy. J Sex Med 2010; 7 (2 Pt 1): 803–809.
Kimura M, Mouraviev V, Tsivian M, Moreira DM, Mayes JM, Polascik TJ . Analysis of urinary function using validated instruments and uroflowmetry after primary and salvage prostate cryoablation. Urology 2010; 76: 1258–1265.
Anastasiadis AG, Sachdev R, Salomon L, Ghafar MA, Stisser BC, Shabsigh R et al. Comparison of health-related quality of life and prostate-associated symptoms after primary and salvage cryotherapy for prostate cancer. J Cancer Res Clin Oncol 2003; 129: 676–682.
Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S . Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA 2003; 289: 56–64.
DiBlasio CJ, Malcolm JB, Derweesh IH, Womack JH, Kincade MC, Mancini JG et al. Patterns of sexual and erectile dysfunction and response to treatment in patients receiving androgen deprivation therapy for prostate cancer. BJU Int 2008; 102: 39–43.
Sharifi N, Gulley JL, Dahut WL . Androgen deprivation therapy for prostate cancer. JAMA 2005; 294: 238–244.
Fowler Jr FJ, McNaughton Collins M, Walker Corkery E, Elliott DB, Barry MJ . The impact of androgen deprivation on quality of life after radical prostatectomy for prostate carcinoma. Cancer 2002; 95: 287–295.
Salonia A, Zanni G, Gallina A, Sacca A, Sangalli M, Naspro R et al. Baseline potency in candidates for bilateral nerve-sparing radical retropubic prostatectomy. Eur Urol 2006; 50: 360–365.
Salonia A, Gallina A, Briganti A, Zanni G, Sacca A, Deho F et al. Remembered International Index of Erectile Function domain scores are not accurate in assessing preoperative potency in candidates for bilateral nerve-sparing radical retropubic prostatectomy. J Sex Med 2008; 5: 677–683.
Michl UH, Friedrich MG, Graefen M, Haese A, Heinzer H, Huland H . Prediction of postoperative sexual function after nerve sparing radical retropubic prostatectomy. J Urol 2006; 176: 227–231.
We appreciate the support of the Josiah Charles Trent Memorial Foundation that provided funding for this research.
The authors declare no conflict of interest.
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Kimura, M., Donatucci, C., Tsivian, M. et al. On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation. Int J Impot Res 23, 49–55 (2011). https://doi.org/10.1038/ijir.2011.3
- prostate cancer