Cryosurgical Ablation Of The Prostate Research Articles

1129: Primary Cryosurgical Ablation of the Prostate (TCAP): 8-Year Experience

1129: Primary Cryosurgical Ablation of the Prostate (TCAP): 8-Year Experience

Feasibility of Nerve-Sparing Prostate Cryosurgery: Applications and Limitations in a Canine Model

In a canine model, we evaluated the feasibility of nerve-sparing cryosurgery by active warming of the neurovascular bundle (NVB). Furthermore, our aim was to determine if NVB warming increases the risk of acinar gland and stromal-tissue preservation in adjacent areas of the prostate. The effects of a single versus double freeze-thaw cycle on prostate tissue were also assessed. Ten prostate lobes from five dogs were evaluated. Nine lobes from five dogs were treated with cryoablation using 17-gauge gas-driven cryoneedles. Seven lobes wre treated with active warming of the NVB using helium gas, and two lobes were treated without active warming. A single or double freeze-thaw cycle was utilized. Prostate tissue ablation and NVB preservation were evaluated in histologic sections. All seven prostate lobes treated with active warming demonstrated complete or partial NVB preservation. Four of these lobes had adjacent gland preservation. All lobes treated with a double freeze-thaw cycle showed complete and uniform ablation of prostate tissue. One of the three lobes treated with a single freeze-thaw cycle demonstrated incomplete ablation of the tissue. This is the first study investigating the feasibility of NVB preservation under controlled experimental conditions. In our canine model, NVB preservation with active warming was possible but not consistently reproducible. In some cases, NVB preservation with active warming may result in incomplete peripheral tissue ablation. A double, but not a single, freeze-thaw cycle induces complete and effective necrosis of prostatic tissue. These results have significant clinical applications when attempting nerve-sparing cryosurgical ablation of the prostate.

1662: Salvage Cryosurgical Ablation of the Prostate (TCAP) for Patients Failing Radiation: 10-Year Experience

1662: Salvage Cryosurgical Ablation of the Prostate (TCAP) for Patients Failing Radiation: 10-Year Experience

Cryosurgical ablation of the prostate

The authors report their experience with cryosurgical ablation of the prostate in men with high-risk features for prostate carcinoma who were unwilling to undergo radical surgery or radiation therapy. Between January 1998 and April 2002, 65 men underwent primary cryosurgery for prostate carcinoma with high-risk features. All patients had biopsy-proven prostate carcinoma without evidence for metastatic disease on magnetic resonance images, computed tomography scans, or radionuclide images of bones. High-risk parameters were defined as either a prostate-specific antigen (PSA) level >/= 10 ng/mL, or a Gleason sum score >/= 8, or both. Patients who had undergone prior surgery, radiation therapy, or cryoablation for prostate carcinoma were excluded from the study. Patients were monitored with physical examination and PSA screening every 3 months and with radiologic imaging when indicated. The median patient age was 72 years (range, 41-86 years), and t he median follow-up was 35 months (range, 4-77 months). There were 2 patients (3.1%) with rectal pain and incontinence. Durable PSA biochemical disease-free survival was noted in 83.3% of patients according to the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria. A 6-year Kaplan-Meier analysis revealed an 81.7% ASTRO survival probability as well as PSA nadir < 4.0 ng/mL and PSA nadir < 1.0 ng/mL projections of 50% and 35%, respectively. One of 8 postcryosurgery biopsies (12.5%) were positive. No patient had progressed at last follow-up, and the overall survival rate was 100%. Cryoablation was a feasible treatment option in patients with organ-confined prostate carcinoma who had high-risk features. Longer follow-up will be necessary to determine the effectiveness of this approach.

1028: Targeted Cryosurgical Ablation of the Prostate (TCAP) for Patients Failing Radiation: 6-Year Observations

You have accessJournal of UrologyDiscussed Poster, Monday, May 10, 2004, 1:00 - 5:00 pm1 Apr 20041028: Targeted Cryosurgical Ablation of the Prostate (TCAP) for Patients Failing Radiation: 6-Year Observations Aaron E. Katz Aaron E. KatzAaron E. Katz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38265-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1028: Targeted Cryosurgical Ablation of the Prostate (TCAP) for Patients Failing Radiation: 6-Year Observations." The Journal of Urology, 171(4S), p. 272 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 272 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Aaron E. Katz More articles by this author Expand All Advertisement PDF downloadLoading ...

Treatment of Organ Confined Prostate Cancer with Third Generation Cryosurgery: Preliminary Multicenter Experience

Cryosurgical ablation of the prostate is 1 approach to the treatment of localized prostate cancer. Third generation cryosurgery uses gas driven probes that allow for a decrease in probe diameter to 17 gauge (1.5 mm). The safety, morbidity and preliminary prostate specific antigen (PSA) results of 122 cases are reported. A total of 106 patients have undergone percutaneous cryosurgery using a brachytherapy template with at least 12 months of PSA followup. Immediate and delayed morbidities were evaluated. PSA results at 3 and 12 months were recorded, and failure was defined as the inability to reach a nadir of 0.4 ng/ml or less. Complications in patients undergoing primary cryosurgery included tissue sloughing (5%), incontinence (pads, 3%), urge incontinence/no pads (5%), transient urinary retention (3.3%) and rectal discomfort (2.6%). There were no cases of fistulas or infections. Postoperative impotence was 87% in previously potent patients. For patients who underwent salvage cryosurgery there were no fistulas reported and 2 (11%) patients required pads after salvage cryosurgery. A total of 96 (81%) patients achieved a PSA nadir of 0.4 ng/ml or less at 3 months of followup, while 79 of 106 (75%) remained free from biochemical recurrence at 12 months. A total of 42 (78%) low risk patients (Gleason score 7 or less and PSA 10 or less) remained with a PSA of 0.4 ng/ml or less at 12 months of followup, compared to 37 (71%) high risk patients. All patients were discharged within 24 hours. After a followup of 1 year 3rd generation cryosurgery appears to be well tolerated and minimally invasive. The use of ultrathin needles through a brachytherapy template allows for a simple percutaneous procedure and a relatively short learning curve. A prospective multicenter trial is ongoing to determine the long-term efficacy of this technique.

Alternative therapies for localized prostate cancer.

Prostate cancer is the leading malignancy in men; an increase in detected localized prostate cancers is expected in the years to come. Radical prostatectomy, although effective, is associated with a considerable morbidity. The aim of minimal invasive alternative treatment options should be equal efficacy, but a decrease in side effects. Cryosurgical ablation of the prostate, brachytherapy, high-intensity focused ultrasound, and radiofrequency interstitial tumor ablation were evaluated after a literature review from a MEDLINE search (1966-2002). When compared with treatments in the 1960s and 1970s, increased safety is observed in all of the alternative treatments available today. Sophisticated technology, including the latest ultrasonography devices for exact planning and monitoring of treatment, contributes largely to this safety. Five-year results of cryosurgical ablation of the prostate show a prostate-specific antigen lower than 1 ng/mL in 60% of the cases; in the third generation, there are no long-term data available on cryosurgical ablation of the prostate. Recent outcome data of brachytherapy come close to results of radical prostatectomy series. Brachytherapy is the only true alternative at this point in time. High-intensity focused ultrasound and radiofrequency interstitial tumor ablation are promising new technologies that have proven to be able to induce extensive necrosis; however, follow-up is too short to determine their definite places in the treatment of prostate cancer.

Cryosurgery for prostate cancer.

Choice of management for patients with prostate cancer is influenced by patient and disease characteristics and life expectancy. Management options include expectance (watchful waiting), radical prostatectomy, external beam radiotherapy, brachytherapy, and cryosurgical ablation of the prostate (CSAP). The role of cryotherapy in the management of prostate cancer is still evolving. Continued research has allowed the introduction of efficient and safe cryosurgical equipment exemplified by the current third-generation cryosurgical machines. CSAP can be performed in an ambulatory surgery setting or as inpatient surgery with overnight stay. The procedure is performed under continuous ultrasonic monitoring. Mature data from the use of second-generation cryosurgical equipment indicate that CSAP is an effective therapeutic modality for managing patients with prostate cancer. Current data with the third-generation cryosurgical equipment are not mature. However, the favorable side effect profile and the good early responses seem to indicate that this modality will have a prominent role in the management of patients with prostate cancer.

Rectal Wall Recurrence of Prostatic Adenocarcinoma

Case 1. A 60-year-old man was treated with 72 Gy. external beam radiation therapy for Gleason score 4 3 adenocarcinoma of the prostate diagnosed by transrectal ultrasound guided biopsy. After treatment prostate specific antigen (PSA) decreased to 1.3 ng./ml. One year later PSA had increased to 2.0 ng./ml. Transrectal ultrasound guided biopsy revealed recurrent prostatic adenocarcinoma. Salvage cryosurgical ablation of the prostate was then performed, after which PSA decreased to less than 0.5 ng./ml. Three years after primary therapy, repeat transrectal ultrasound was performed for a superficial palpable nodule noted on digital rectal examination. At that time PSA was 1.8 ng./ml. Transrectal ultrasound demonstrated a fusiform mass in the rectal wall. Biopsy of the mass showed Gleason score 4 4 adenocarcinoma. The patient subsequently received hormone ablation therapy. Six years after initial treatment he is living with hormone refractory prostate cancer. Case 2. A 74-year-old man underwent cryosurgical ablation of the prostate for Gleason score 2 3 adenocarcinoma, which was detected by transrectal ultrasound guided biopsy. Sixteen months after cryotherapy PSA had increased to 6.0 ng./ml. and transrectal ultrasound guided biopsy revealed Gleason score 3 4 adenocarcinoma. Salvage cryosurgical ablation of the prostate was then performed, after which PSA decreased to less than 0.1 ng./ml. Forty-two months after the second cryoablation transrectal ultrasound was performed for increasing PSA and a palpable mass on digital rectal examination. The scan demonstrated a fusiform hypoechoic lesion within the muscularis propria of the rectum (see figure). Biopsies of the mass showed Gleason score 3 4 adenocarcinoma. The patient was subsequently treated with external beam radiation therapy, and PSA was undetectable 27 months after treatment.

Prospective trial of cryosurgical ablation of the prostate: five-year results

Objectives To determine in a prospective pilot study the safety and efficacy of cryosurgical ablation for localized prostate carcinoma. Methods A total of 87 cryosurgical procedures were performed on 76 consecutive patients between December 1994 and February 1998. All patients had histologically proved adenocarcinoma of the prostate, with prostate-specific antigen (PSA) readings of less than 30 ng/mL. Clinical evaluations, PSA determinations, and patient self-reported quality-of-life questionnaires (functional assessment of cancer treatment-prostate; FACT-P) were used to determine biochemical and clinical disease-free status and complications. Patients had a mean follow-up of 50 months (minimum 36). Results Follow-up biopsies were performed in 73 patients, and 72 were negative for malignancy after one or more treatments. Ten patients required two treatments and 1 patient required three treatments. The 5-year overall and cancer-specific survival rate was 89% (95% confidence interval, 83% to 97%) and 98.6% (95% confidence interval, 96% to 100%), respectively. The undetectable PSA rate (less than 0.3 ng/mL) for low-risk patients (n = 13) was 60% at 5 years; for moderate-risk patients (n = 23), it was 77%, and for high-risk patients (n = 40), 48%. The corresponding percentage of patients with a PSA level less than 1.0 ng/mL at 5 years was 75%, 89%, and 76%. Sloughing occurred in 3 patients (3.9%), incontinence in 1 (1.3%), and testicular abscess in 1 (1.3%). At 3 years, 18 (47%) of 38 patients capable of unassisted intercourse at the time of cryosurgery had resumed sexual intercourse, 5 spontaneously and 13 with sildenafil or prostaglandin. Conclusions The results of this prospective evaluation show cryosurgery to be both a safe and an effective option in the treatment of localized prostate cancer.

SALVAGE CRYOTHERAPY USING AN ARGON BASED SYSTEM FOR LOCALLY RECURRENT PROSTATE CANCER AFTER RADIATION THERAPY: THE COLUMBIA EXPERIENCE

Cryosurgical ablation of the prostate has been reported as potential treatment for radioresistant clinically localized prostate cancer. We report our experience with the safety and efficacy of salvage cryosurgery using the argon based CRYOCare system (Endocare, Inc, Irvine, California). Between October 1997 and September 2000, 38 men with a mean age of 71.9 years underwent salvage cryosurgery for recurrent prostate cancer after radiation therapy failed. All patients had biochemical disease recurrence, defined as an increase in prostate specific antigen (PSA) of greater than 0.3 ng./ml. above the post-radiation PSA nadir. Subsequently prostate biopsy was positive for cancer. Pre-cryosurgery bone scan demonstrated no evidence of metastatic disease. In addition, these patients received 3 months of neoadjuvant androgen deprivation therapy before cryotherapy. The PSA nadir was 0.1 or less, 1 or less and greater than 1 ng./ml. in 31 (81.5%), 5 (13.2%) and 2 (5.3%) patients, respectively. Biochemical recurrence-free survival calculated from Kaplan-Meier curves was 86% at 1 year and 74% at 2 years. Reported complications included rectal pain in 39.5% of cases, urinary tract infection in 2.6%, incontinence in 7.9%, hematuria in 7.9% and scrotal edema in 10.5%. The rate of rectourethral fistula, urethral sloughing and urinary retention was 0%. Our study supports cryosurgery of the prostate as safe and effective treatment in patients in whom radiation therapy fails. Using the CRYOCare machine resulted in a marked decrease in complications.

THE USE OF A RECTUS MUSCLE FLAP IN THE REPAIR OF A PROSTATO-RECTAL FISTULA

Prostato-rectal fistulae secondary to external beam radiation and cryosurgery are extremely challenging surgically. We report on the incorporation of a rectus muscle flap to facilitate healing of this visceral defect. CASE REPORT A 74-year-old man presented with a prostato-rectal fistula. He complained of continuous leakage of urine per the rectum, urinary tract infections and passage of “stones” through the urethra and rectum. History was significant for prostate cancer detected at biopsy 7 years earlier elsewhere after the discovery of increased prostate specific antigen (PSA). Treatment had included approximately 65 Gy. external beam radiation initially and leuprolide acetate after PSA increased. While on leuprolide acetate PSA became undetectable but for unclear reasons cryosurgical ablation of the prostate was performed. A prostato-rectal fistula developed postoperatively, which was treated unsuccessfully elsewhere with a diverting colostomy. Excretory urogram showed normal upper tracts and filling defects in the bladder. Cystoscopy revealed foreign bodies, which appeared to be fecaliths. There was a fistula, approximately the size of an index finger, leading from the prostatic fossa to the rectum. Because of the heavily irradiated tissue and prior use of a cryosurgical probe, we elected to use a vascularized tissue flap. A transabdominal appproach was used to close the fistula. Abdominal adhesions were lysed and the bladder was opened. Multiple fecaliths were removed from the bladder. The bladder was then bivalved from the dome down through the trigone until the fistulous tract was reached. Stay sutures were placed on either side of the fistula and the tract was cored out. The rectal defect was closed in 2 layers with 2-zero polydioxanone sutures and a right rectus abdominis flap based on the inferior epigastric pedicle was mobilized and placed over the rectal closure. Because of the tenuous nature of the posterior prostate fossa and bladder wall, the rectus flap was incorporated into the bladder closure between the halves of the bladder. Ureteral stents and a 3-way urethral catheter were used for drainage. A cystogram on postoperative day 17 showed no bladder leak and successful closure of the fistula (see figure). The patient plans to have the colostomy closed at a future date.

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Objectives. To define the potential role of cryosurgical ablation of the prostate (CSAP) as a treatment option for patients with localized prostate carcinoma (PCA), we performed a retrospective outcomes analysis of a large database of patients undergoing CSAP constructed from five institutions and compared this with matching outcomes from contemporary reports of patient outcomes after radiotherapy. Methods. A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of their clinical features. Biochemical-free survival (BFS), post-CSAP biopsy results, and post-CSAP morbidities were calculated and recorded. Results. The median follow-up for all patients was 24 months. The percentages of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0.5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%. Morbidities included impotence in 93%, incontinence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 40% nonapproved). Conclusions. For each risk group, the 5-year BFS and positive biopsy rate after CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-related results comparable to those reported for patients undergoing radiotherapy.

Salvage radiotherapy for prostate cancer recurrence after cryosurgical ablation

Objectives. To retrospectively determine the outcome of patients treated with salvage three-dimensional conformal radiotherapy (RT) for prostate cancer recurrence after cryosurgical ablation of the prostate (CSAP). Biochemical control rates and morbidity were analyzed. Methods. Between January 1990 and November 1999, a total of 49 patients initially treated with CSAP were later irradiated because of a rising prostate-specific antigen (PSA) level and/or a positive biopsy at Allegheny General Hospital. The clinical stage before cryosurgery was T1c in 7 patients; T2a in 7 patients; T2b in 10 patients; T3 in 17 patients; and T4 and/or N1 in 8 patients. The Gleason score was 6 or lower in 29 patients, 7 in 11 patients, and 8 or higher in 9 patients. The mean pre-CSAP PSA level was 15.7 ng/mL (range 2.4 to 45). One patient had a PSA level less than 4 ng/mL, 16 had a PSA level of 4 to 10 ng/mL, 21 had a PSA level of 10 to 20 ng/mL, and 11 had a PSA level greater than 20 ng/mL. Before the start of RT, a complete restaging workup was performed and was negative for distant metastatic disease in all 49 patients. The mean interval to recurrence after CSAP was 19 months (range 3 to 78). The mean RT dose to the planning target volume was 62.9 Gy (range 50.4 to 68.4). Results. The mean pre-RT PSA level was 2.4 ng/mL (range 0.1 to 7.4). After RT, the mean nadir PSA level was 0.4 ng/mL (range 0 to 4.2). The mean time to PSA nadir was 5.8 months (range 1 to 15). In 42 patients, the PSA nadir was less than 1.0 ng/mL, in 5 patients the PSA nadir was greater than 1 ng/mL, and in 2 patients the PSA level remained stable. With a median follow-up time of 32 months (range 12 to 85), the overall biochemical control rate was 61%. The mean time to biochemical failure was 14.5 months (range 1 to 47). Of 30 patients with a pre-RT PSA level of 2.5 ng/mL or less, the disease of 22 (73%) was controlled compared with only 8 (42%) of 19 with a pre-RT PSA level greater than 2.5 ng/mL ( P = 0.040). Biochemical control occurred in 18 (69%) of 26 patients with a dose of 64 Gy or greater compared with only 12 (52%) of 23 patients with a dose of less than 64 Gy ( P = 0.024). The disease of 20 (70%) of 29 patients with a Gleason score of 6 or lower was controlled versus 10 (50%) of 20 patients with a Gleason score of 7 or greater ( P = 0.064). Only 2 patients developed subacute morbidity (proctitis and a urethral stricture). All complications resolved with conservative measures. Conclusions. Salvage RT for prostate cancer recurrence after CSAP appears feasible. Our preliminary experience revealed that post-CSAP RT in patients with prostate cancer appears to effectively diminish the post-RT PSA level to a nadir of 1.0 ng/mL or less in most patients. The pre-RT PSA level and radiation dose may be important predictors of biochemical control in the salvage setting. RT as described was associated with minimal toxicity to the gastrointestinal/genitourinary systems. Additional prospective randomized studies are necessary to better assess the role of RT in the treatment of these patients.

Cryosurgery for prostate cancer: new technology and indications.

Patients diagnosed with prostate cancer who elect to pursue active treatment of their disease must choose among the many available treatment alternatives. Several treatment options now exist for similar-stage disease (clinical T1-3N0M0), including radical prostatectomy, external beam radiation, prostate brachytherapy (PB), and cryosurgical ablation of the prostate (CSAP). This article reviews the current role of CSAP in the treatment of clinically localized prostate cancer. CSAP has a role in the primary treatment of men with high-risk, clinically localized prostate cancer (defined as PSA >10, Gleason score >or=7, or clinical stage >or= cT2B). CSAP (occasionally followed by external beam radiotherapy) appears to offer improved rates of cancer control over other types of single or combination therapies for this high-risk prostate cancer, and it is associated with an acceptable side-effect profile. CSAP should also be the treatment of choice for men with recurrent local disease who have undergone external beam radiotherapy or PB.

TOTAL CRYOSURGERY OF THE PROSTATE VERSUS STANDARD CRYOSURGERY VERSUS RADICAL PROSTATECTOMY: COMPARISON OF EARLY RESULTS AND THE ROLE OF TRANSURETHRAL RESECTION IN CRYOSURGERY

Results of standard cryosurgery of the prostate for prostate cancer in 49 patients were compared to those of destruction of the urethra during or after cryosurgery with subsequent transurethral resection or total freezing of the prostate (total cryosurgery) in 27. These results were compared to those of radical surgery in 83 patients with similar age, stage and grade of disease, and prostate specific antigen (PSA). The 76 cryosurgery cases included all of those treated by 1 surgeon (R. S. G.) for localized prostate cancer after July 1, 1995. The 83 radical perineal prostatectomy cases consisted of all of those treated by another surgeon during the study period and by R. S. G. before cryosurgery use. Success was defined as a PSA of 0.2 or less 6 months after the procedure and a stricter standard, 0.0 PSA, was also assessed. The success rate was 96% for total cryosurgery, 48.9% for standard cryosurgery and 73.4% for radical surgery. Using 0.0 PSA as a criterion, 66.7% of total cryosurgery, 16.3% of standard cryosurgery and 48.2% of radical surgery cases were successfully treated. Total cryosurgical destruction of the prostate may offer new opportunities for cancer treatment heretofore unrecognized and should undergo more investigational analysis.

Balloon Dilation of Posterior Urethral Stricture Secondary to Radiation and Cryotherapy in a Patient with a Functional Artificial Urethral Sphincter

Severe urethral stricture disease as an isolated entity can be a management dilemma. In the patient described here, this problem was associated with prior external-beam radiation and cryosurgical ablation of the prostate, and a functional artificial urethral sphincter (AUS) had been placed. An attempt to relieve partial urinary obstruction while preserving AUS function led to successful balloon dilation proximal to the sphincter cuff.

Comparison of the hospital costs for radical prostatectomy and cryosurgical ablation of the prostate

Objectives. To compare the hospital costs of radical prostatectomy (RP) and cryosurgical ablation of the prostate (CSAP). Methods. All patients who underwent either RP or CSAP at Allegheny General Hospital during an 18-month period beginning in January 1995 were included in this study. Hospital costs were generated for each case, and a chart review was undertaken for each patient. Costs were obtained from the hospital accounting office and divided into 11 categories, including total costs. Pretreatment grade, clinical stage, and prostate-specific antigen level were obtained from the patient’s chart. Noncost information such as length of stay, number of operating room units charged, and patient age were also obtained from the hospital record. Results. Sixty-seven men underwent RP and 114 men underwent CSAP during the study period. Average hospital costs were $4150 for men undergoing CSAP and $5660 for men undergoing RP, a difference of 27.2% ( P < 0.001). The difference in hospital costs was almost completely explained by the difference in room costs ($682 for CSAP and $2348 for RP). Length of stay was 1.1 days for CSAP and 3.5 days for RP. Average operating room costs were higher for CSAP ($2309) than for RP ($1326). Conclusions. As costs become an ever more critical factor in healthcare, the costs of various treatment options for clinically localized prostate cancer will become as important as clinical outcomes in deciding appropriate treatment. From a strictly financial perspective, CSAP is a viable treatment option for clinically localized prostate cancer.

The Effect of Cryosurgical Ablation of the Prostate on Erectile Dysfunction

The Effect of Cryosurgical Ablation of the Prostate on Erectile Dysfunction

The Effect of Cryosurgical Ablation of the Prostate on Erectile Dysfunction

Objective To investigate the incidence and identify the possible cause of erectile dysfunction after cryoablation of the prostate. Patients and methods Erectile function was examined prospectively in 15 sexually active men (aged 59–72 years) who underwent cryoablation of the prostate for clinically localized prostate cancer. Erectile function was assessed before and 6 months after treatment; after intracavernosal injection with 10 μg of prostaglandin E1 (PGE1), the degree and duration of erection, the size of the cavernosal arteries, the penile arterial blood flow velocity, and the time to achieve peak flow were evaluated using high-resolution ultrasonography and colour pulsed-Doppler spectral analysis. Results Post-operatively, all patients initially reported an inability to achieve an erection sufficient for vaginal intercourse. At 6 months′ follow-up, erectile dysfunction persisted in nine, with minimal or no response to the intracavernosal PGE1 injections, there was a significant decrease in the peak velocity of blood flow within cavernosal arteries and a significant increase in the time to achieve peak arterial flow. Conclusion Although many factors may contribute to erectile dysfunction after cryoablation of the prostate, vascular injury plays a major role.