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A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review.

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Title: A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review.
Authors: Faure Walker, NA
Norris, JM
Shah, TT
Yap, T
Cathcart, P
Moore, CM
Ahmed, HU
Emberton, M
Minhas, S
Item Type: Journal Article
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.
Issue Date: 22-Dec-2017
Date of Acceptance: 4-Dec-2017
URI: http://hdl.handle.net/10044/1/56004
DOI: https://dx.doi.org/10.1016/j.urolonc.2017.12.002
ISSN: 1078-1439
Publisher: Elsevier
Start Page: 67
End Page: 76
Journal / Book Title: Urologic Oncology: Seminars and Original Investigations
Volume: 36
Issue: 2
Copyright Statement: © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: Wellcome Trust
University College London Hospitals Charity
Funder's Grant Number: 204998/Z/16/Z
Keywords: Cryotherapy
Erectile dysfunction
Focal therapy
1112 Oncology And Carcinogenesis
Urology & Nephrology
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer