Skip to main content

Advertisement

SpringerLink
Log in

Voiding Dysfunction, Incontinence, and Erectile Dysfunction Following High-Intensity Focus Ultrasound and Focal Cryotherapy in Treatment of Prostate Cancer

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Prostate cancer is one of the most prevalent malignancies in males and treatment is not infrequently associated with substantial morbidity. As a result, there has been growing interest in alternative therapies for prostate cancer therapy including high-intensity focused ultrasound (HIFU) and focal cryoablation. Herein, we review the potential genitourinary sequelae of these therapies including incontinence and erectile dysfunction.

Recent Findings

Various studies have demonstrated that with improvements in delivery technique and technologies aimed at treatment of prostate cancer, the risks of urinary incontinence, urethral obstruction, and erectile dysfunction have decreased. Large studies demonstrate rates of continence in 84–100% of patients and potency in 44–77% of patients treated with HIFU. Focal cryoablation incontinence rates can be as low as 1.6% and erectile function may be preserved in 68.8% of patients.

Summary

Urinary incontinence and erectile dysfunction rates are lower in patients treated with HIFU or focal cryoablation compared to patients treated with traditional therapies. However, HIFU patients may experience higher rates of urethral stricture and bladder neck obstruction compared to traditional therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  PubMed  Google Scholar 

  2. Miller KD, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.

    Article  PubMed  Google Scholar 

  3. Attard G, et al. Prostate cancer. Lancet. 2016;387(10013):70–82.

    Article  PubMed  Google Scholar 

  4. Harris MJ. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management. Eur Urol. 2003;44(3):303–8.

    Article  PubMed  Google Scholar 

  5. Donovan JL, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Peterson AC, Chen Y. Patient reported incontinence after radical prostatectomy is more common than expected and not associated with the nerve sparing technique: results from the Center for Prostate Disease Research (CPDR) database. Neurourol Urodyn. 2012;31(1):60–3.

    Article  PubMed  Google Scholar 

  7. Wortel RC, et al. Late side effects after image guided intensity modulated radiation therapy compared to 3D-conformal radiation therapy for prostate cancer: results from 2 prospective cohorts. Int J Radiat Oncol Biol Phys. 2016;95(2):680–9.

    Article  PubMed  Google Scholar 

  8. Madersbacher S, et al. Effect of high-intensity focused ultrasound on human prostate cancer in vivo. Cancer Res. 1995;55(15):3346–51.

    CAS  PubMed  Google Scholar 

  9. Poissonnier L, et al. Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol. 2007;51(2):381–7.

    Article  CAS  PubMed  Google Scholar 

  10. Blana A, et al. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology. 2004;63(2):297–300.

    Article  PubMed  Google Scholar 

  11. Ahmed HU, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol. 2015;68(6):927–36.

    Article  PubMed  Google Scholar 

  12. Feijoo ER, et al. Focal high-intensity focused ultrasound targeted hemiablation for unilateral prostate cancer: a prospective evaluation of oncologic and functional outcomes. Eur Urol. 2016;69(2):214–20.

    Article  PubMed  Google Scholar 

  13. Tal R, et al. Erectile function recovery rate after radical prostatectomy: a meta-analysis. J Sex Med. 2009;6(9):2538–46.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ficarra V, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405–17.

    Article  PubMed  Google Scholar 

  15. Frey, A., et al., Prevalence and predicting factors for commonly neglected sexual side effects to external-beam radiation therapy for prostate cancer. J Sex Med, 2017.

  16. Ahmed HU, et al. Focal therapy for localized prostate cancer: a phase I/II trial. J Urol. 2011;185(4):1246–54.

    Article  CAS  PubMed  Google Scholar 

  17. Hu JC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;302(14):1557–64.

    Article  CAS  PubMed  Google Scholar 

  18. Muto S, et al. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol. 2008;38(3):192–9.

    Article  PubMed  Google Scholar 

  19. Crouzet S, et al. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol. 2014;65(5):907–14.

    Article  PubMed  Google Scholar 

  20. Hatiboglu G, et al. Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. BMC Urol. 2017;17(1):5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Uchida T, et al. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. J Urol. 2015;193(1):103–10.

    Article  PubMed  Google Scholar 

  22. Van Velthoven R, et al. Primary zonal high intensity focused ultrasound for prostate cancer: results of a prospective phase IIa feasibility study. Prostate Cancer. 2014;2014:756189.

    PubMed  PubMed Central  Google Scholar 

  23. Blana A, et al. Eight years’ experience with high-intensity focused ultrasonography for treatment of localized prostate cancer. Urology. 2008;72(6):1329–33. discussion 1333-4

    Article  PubMed  Google Scholar 

  24. Ahmed HU, et al. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol. 2012;13(6):622–32.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dickinson L, Ahmed H, McCartan N, et al. Medium term outcomes following primary focal therapy using HIFU for localised prostate cancer. BJU Int. 2012;109(Suppl S7):6.

    Google Scholar 

  26. Gage AA. History of cryosurgery. Semin Surg Oncol. 1998;14(2):99–109.

    Article  CAS  PubMed  Google Scholar 

  27. Cooper IS, Lee AS. Cryostatic congelation: a system for producing a limited, controlled region of cooling or freezing of biologic tissues. J Nerv Ment Dis. 1961;133:259–63.

    Article  CAS  PubMed  Google Scholar 

  28. Addonizio JC. Another look at cryoprostatectomy. Cryobiology. 1982;19(3):223–7.

    Article  CAS  PubMed  Google Scholar 

  29. Onik GM, et al. Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer. 1993;72(4):1291–9.

    Article  CAS  PubMed  Google Scholar 

  30. Hu JC, Lin DW. Current status of focal primary therapy for prostate cancer. Urol Oncol. 2012;30(6):942–3.

    Article  PubMed  Google Scholar 

  31. Mohammed A, et al. Cryotherapy and its applications in the management of urologic malignancies: a review of its use in prostate and renal cancers. Urol Oncol. 2014;32(1):39 e19–27.

    Article  Google Scholar 

  32. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60(2):40–9.

    Article  PubMed  Google Scholar 

  33. Zacarian SA, Stone D, Clater M. Effects of cryogenic temperatures on microcirculation in the golden hamster cheek pouch. Cryobiology. 1970;7(1):27–39.

    Article  CAS  PubMed  Google Scholar 

  34. Baust JM, Van B, Baust JG. Cell viability improves following inhibition of cryopreservation-induced apoptosis. In Vitro Cell Dev Biol Anim. 2000;36(4):262–70.

    Article  CAS  PubMed  Google Scholar 

  35. Matin SF, et al. Immunological response to renal cryoablation in an in vivo orthotopic renal cell carcinoma murine model. J Urol. 2010;183(1):333–8.

    Article  PubMed  Google Scholar 

  36. Mendez MH, et al. Comparison of outcomes between preoperatively potent men treated with focal versus whole gland cryotherapy in a matched population. J Endourol. 2015;29(10):1193–8.

    Article  PubMed  Google Scholar 

  37. Tay KJ, et al. Primary cryotherapy for high-grade clinically localized prostate cancer: oncologic and functional outcomes from the COLD registry. J Endourol. 2016;30(1):43–8.

    Article  PubMed  Google Scholar 

  38. 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(11):1648–54.

    Article  PubMed  Google Scholar 

  39. Durand M, et al. Focal cryoablation: a treatment option for unilateral low-risk prostate cancer. BJU Int. 2014;113(1):56–64.

    Article  PubMed  Google Scholar 

  40. Barqawi AB, et al. Targeted focal therapy for the management of organ confined prostate cancer. J Urol. 2014;192(3):749–53.

    Article  PubMed  Google Scholar 

  41. Onik G, et al. Focal “nerve-sparing” cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency. Urology. 2002;60(1):109–14.

    Article  PubMed  Google Scholar 

  42. Ellis DS, Manny TB Jr, Rewcastle JC. Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results. Urology. 2007;70(6 Suppl):9–15.

    Article  PubMed  Google Scholar 

  43. Lambert EH, et al. Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology. 2007;69(6):1117–20.

    Article  PubMed  Google Scholar 

  44. Truesdale MD, et al. An evaluation of patient selection criteria on predicting progression-free survival after primary focal unilateral nerve-sparing cryoablation for prostate cancer: recommendations for follow up. Cancer J. 2010;16(5):544–9.

    Article  PubMed  Google Scholar 

  45. Lian H, et al. Focal cryoablation for unilateral low-intermediate-risk prostate cancer: 63-month mean follow-up results of 41 patients. Int Urol Nephrol. 2016;48(1):85–90.

    Article  PubMed  Google Scholar 

  46. Jones JS, et al. Whole gland primary prostate cryoablation: initial results from the cryo on-line data registry. J Urol. 2008;180(2):554–8.

    Article  PubMed  Google Scholar 

  47. Asterling S, Greene DR. Prospective evaluation of sexual function in patients receiving cryosurgery as a primary radical treatment for localized prostate cancer. BJU Int. 2009;103(6):788–92.

    Article  PubMed  Google Scholar 

  48. Bahn D, et al. Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol. 2012;62(1):55–63.

    Article  PubMed  Google Scholar 

  49. Hale Z, et al. Focal cryosurgical ablation of the prostate: a single institute's perspective. BMC Urol. 2013;13:2.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Urology, Duke University Medical Center, P.O. Box 3146, Durham, NC, 27710, USA

    Doreen Chang, Ramiro J. Madden-Fuentes & Andrew C. Peterson

Authors
  1. Doreen Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramiro J. Madden-Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew C. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew C. Peterson.

Ethics declarations

Conflict of Interest

Drs. Chang, Peterson, and Madden-Fuentes declare that Boston Scientific supports an educational fellowship grant for the reconstructive urology fellowship program.

Dr. Peterson also reports grants from American medical systems and Coloplast, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, D., Madden-Fuentes, R.J. & Peterson, A.C. Voiding Dysfunction, Incontinence, and Erectile Dysfunction Following High-Intensity Focus Ultrasound and Focal Cryotherapy in Treatment of Prostate Cancer. Curr Bladder Dysfunct Rep 12, 285–290 (2017). https://doi.org/10.1007/s11884-017-0435-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-017-0435-2

Keywords

Search

Navigation