Cryoablation as Primary Treatment for Localized Prostate Cancer Followed by Penile Rehabilitation

Objectives To determine the medium term efficacy and morbidity of patients who underwent cryoablation as primary therapy for localized prostate cancer followed by a penile rehabilitation regimen. Methods Patients were treated with whole gland cryoablation. Those potent at intervention were encouraged to use a vacuum erection device regularly after treatment. Incontinence was defined as any leakage of urine. Potency was defined as the ability to achieve an erection sufficient to complete intercourse with or without oral pharmaceutical agents. Biochemical failure was defined as three successive rises in prostate-specific antigen, with a final value greater than 1.0 ng/mL. Results A total of 416 consecutive patients were treated. The mean patient age was 69.4 years, mean prostate-specific antigen level was 8.7 ng/mL, median Gleason score was 6, and median stage was T1c. The mean follow-up of the entire population was 20.4 ± 14.7 months. Of those continent before treatment, 4.0% were incontinent at 6 months but only 2 (0.6%) used any absorbent pads. Kaplan-Meier analysis demonstrated progressive recovery of sexual function of preoperatively potent men, with 41.4% ± 4.3% and 51.3% ± 5.9% potent 1 and 4 years after treatment, respectively. No patients had rectal fistula. The actuarial probability of remaining biochemically disease free at 4 years was 79.6% ± 2.4%, with a mean time to failure of 4.2 months. After therapy, 168 patients underwent biopsy; 17 had positive findings (10.1%). The positive biopsy rate for the entire population was 4.1% (17 of 416). Conclusions The results of our study have indicated that cryoablation as a primary treatment of localized prostate cancer is effective with acceptable morbidity. The use of a penile rehabilitation regimen after treatment appeared to substantially increase postcryoablation potency.