title: Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer.
abstract: OBJECTIVE
  To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort.
  
  
  METHODS
  We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant.
  
  
  RESULTS
  After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9%) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7%) regained EF of level 1-2 while 1 (2.9%) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7%) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively).
  
  
  CONCLUSIONS
  Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7%. Further, though erectile dysfunction is common following TCAP, 25.7% of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.
authors.affiliation: Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiBlasio
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
authors.forename: Michael M
authors.initials: MM
authors.lastname: Maddox
authors.forename: Michael A
authors.initials: MA
authors.lastname: Aleman
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wake
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003452:Cryosurgery / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010410:Penile Erection; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D014555:Urination Disorders / Q000209:etiology*
chemical_list: D017430:Prostate-Specific Antigen