Patient-reported quality of life progression in men with prostate cancer following primary cryotherapy, cyberknife, or active holistic surveillance

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Technological advancements have led to the success of minimally invasive treatment modalities for prostate cancer such as CyberKnife and Cryotherapy. Here, we investigate patient-reported urinary function, bowel habits, and sexual function in patients following CyberKnife (CK) or Cryotherapy treatment, and compare them with active holistic surveillance (AHS) patients.


An IRB-approved institutional database was retrospectively reviewed for patients who underwent CK, Cryotherapy, or AHS. Quality of life (QoL) survey responses were collected every three months and the mean function scores were analyzed in yearly intervals over the 4 years post-treatment.


279 patients (767 survey sets) were included in the study. There was no difference among groups in urinary function scores. The CyberKnife group had significantly lower bowel habit scores in the early years following treatment (year 2 mean difference: −5.4, P < 0.01) but returned to AHS level scores by year 4. Cryotherapy patients exhibited initially lower, but not statistically significant, bowel function scores, which then improved and approached those of AHS. Both CyberKnife (year 1 mean difference: −26.7, P < 0.001) and Cryotherapy groups (−35.4, P < 0.001) had early lower sexual function scores relative to AHS, but then gradually improved and were not significantly different from AHS by the third year post-treatment. A history of hormonal therapy was associated with a lower sexual function scores relative to those patients who did not receive hormones in both CyberKnife (−18.45, P < 0.01) and Cryotherapy patients (−14.6, P < 0.05).


After initial lower bowel habits and sexual function scores, CyberKnife or Cryotherapy-treated patients had no significant difference in QoL relative to AHS patients. These results highlight the benefit of CyberKnife and Cryotherapy in the management of organ-confined prostate cancer.

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  1. 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

  2. 2.

    Potosky AL, Legler J, Albertsen PC, Stanford JL, Gilliland FD, Hamilton AS, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the prostate cancer outcomes study. J Natl Cancer Inst. 2000;92:1582–92.

  3. 3.

    Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358:1250–61.

  4. 4.

    Madalinska JB, Essink-Bot M-L, de Koning HJ, Kirkels WJ, van der Maas PJ, Schroder FH. Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol. 2001;19:1619–28

  5. 5.

    Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129–35.

  6. 6.

    Jones JS, Rewcastle JC, Donnelly BJ, Lugnani FM, Pisters LL, Katz AE. et al. Whole gland primary prostate cryoablation: initial results from the cryo on-line data registry. J Urol. 2008;180:554–8.

  7. 7.

    Lambert EH, Bolte K, Masson P, Katz AE. Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology. 2007;69:1117–20.

  8. 8.

    King CR, Lehmann J, Adler JR, Hai J. CyberKnife radiotherapy for localized prostate cancer: rationale and technical feasibility. Technol Cancer Res Treat. 2003;2:25–29.

  9. 9.

    Alkhorayef M, Mahmoud MZ, Alzimami KS, Sulieman A, Fagiri MA. High-intensity focused ultrasound (HIFU) in localized prostate cancer treatment. Polish J Radiol. 2015;80:131.

  10. 10.

    Lindner U, Lawrentschuk N, Trachtenberg J. Focal laser ablation for localized prostate cancer. J Endourol. 2010;24:791–7.

  11. 11.

    Valerio M, Stricker PD, Ahmed HU, Dickinson L, Ponsky L, Shnier R, et al. Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2014;17:343–7.

  12. 12.

    Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33:272–7.

  13. 13.

    Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol. 2009;28:126–31.

  14. 14.

    Berg CJ, Habibian DJ, Katz AE, Kosinski KE, Corcoran AT, Fontes AS. Active holistic surveillance: the nutritional aspect of delayed intervention in prostate cancer. J Nutr Metabolism. 2016;2016:2917065.

  15. 15.

    Habibian DJ, Katz AE. Emerging minimally invasive procedures for focal treatment of organ-confined prostate cancer. Int J Hyperthermia. 2016;32:795–800.

  16. 16.

    Ward JF, Jones JS. Focal cryotherapy for localized prostate cancer: a report from the national Cryo On-Line Database (COLD) Registry. BJU Int. 2012;109:1648–54.

  17. 17.

    Katz AJ, Santoro M, Diblasio F, Ashley R. Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years. Radiat Oncol. 2013;8:118.

  18. 18.

    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):12–8.

  19. 19.

    Barry MJ, Fowler FJ Jr., O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57.

  20. 20.

    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.

  21. 21.

    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;49:822–30.

  22. 22.

    Onik GM, Cohen JK, Reyes GD, Rubinsky B, Chang Z, Baust J. Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer. 1993;72:1291–1291.

  23. 23.

    Ullal AV, Korets R, Katz AE, Wenske S. A report on major complications and biochemical recurrence after primary and salvage cryosurgery for prostate cancer in patients with prior resection for benign prostatic hyperplasia: a single-center experience. Urology. 2013;82:648–52.

  24. 24.

    Vu CC, Haas JA, Katz AE, Witten MR. Prostate-specific antigen bounce following stereotactic body radiation therapy for prostate cancer. Frontiers Oncol. 2014;4:8.

  25. 25.

    Cassel C, Dickersin K, Garber A, Gatsonis C, Gottlieb G, Guest J, et al. Initial national priorities for comparative effectiveness research. 2009.

  26. 26.

    Sox HC, Greenfield S. Comparative effectiveness research: a report from the Institute of Medicine. Ann Intern Med. 2009;151:203–5.

  27. 27.

    Moyer VA. Screening for prostate cancer: US preventive services task force recommendation statement. Ann Intern Med. 2012;157:120–34.

  28. 28.

    Chen RC, Basak R, Meyer AM, Kuo TM, Carpenter WR, Agans RP, et al. Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer. JAMA. 2017;317:1141–50.

  29. 29.

    Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, et al Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years. JAMA. 2017;317:1126–40.

  30. 30.

    Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375:1425–37.

  31. 31.

    Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose–volume effects in radiation-induced rectal injury. Intl J Radiat Oncol Biol Phys. 2010;76:S123–S129.

  32. 32.

    Yu J, Cooper H. A Quantitative Review of Research Design Effects on Response Rates to Questionnaires. J Mark Res. 1983;20:36–44.

  33. 33.

    Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003;4:529–36.

  34. 34.

    Rodriguez E, Finley DS, Skarecky D, Ahlering TE. Single institution 2-year patient reported validated sexual function outcomes after nerve sparing robot assisted radical prostatectomy. J Urol. 2009;181:259–63.

  35. 35.

    Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology. 2000;55:58–61.

  36. 36.

    Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol. 2001;165:445–54.

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G.T.W. was supported by Medical Scientist Training Program award T32GM008444 and National Research Service Award F30AI112252 from the NIH.

Author information


  1. Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA

    • Glenn T. Werneburg
    • , Jeffrey T. Schiff
    •  & Aaron E. Katz
  2. Department of Urology, NYU Winthrop Hospital, Mineola, NY, 11501, USA

    • Michael Kongnyuy
    • , Daniel M. Halpern
    • , Jose M. Salcedo
    • , Kaitlin E. Kosinski
    • , Jeffrey T. Schiff
    • , Anthony T. Corcoran
    •  & Aaron E. Katz
  3. Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, 11501, USA

    • Jonathan A. Haas


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Conflict of interest

JAH has received speaker honoraria from Accuray, the manufacturer of CyberKnife.

Corresponding author

Correspondence to Glenn T. Werneburg.