UroToday - Penile length and girth are reportedly decreased following radical prostatectomy for prostate cancer (CaP). However, it is not known whether patients experience similar shortcomings after HIFU or targeted cryoablation of the prostate (TCAP). A report in the online version of the Journal of Sexual Medicine by Dr. Li and colleagues form China evaluates this issue.

The study was a non-randomized prospective assessment of differences in erectile function and penile size in men undergoing HIFU or TCAP for clinically localized CaP. Entry criteria also included IIEF-EF scores >26 prior to treatment, normal serum total testosterone and no prior hormonal therapy. For HIFU the Sonoblate 500 device was used and for TCAP treatment an argon-based cryotherapy system was used. Color-duplex ultrasonography was performed following a single intracavernosal injection of PGE1 (20ug) followed by stimulation. Artificial tumescence was graded I-IV (I worst, IV best) by a physician observer. Penile length was measured from the tip of the glans to the pubopenile skin junction and penile circumference was measured at the middle third of the penile shaft. The study included an evaluation of intra-observer variability in a group of 10 men. Following treatment, all men underwent penile rehabilitation using sildenafil sulfate 3 times weekly and they were encouraged to also use an erection vacuum device once daily. Post-treatment assessment was performed using IIEF-EF scores, serum testosterone levels, penile Doppler ultrasound and penile size at 6, 12, 18, 24, and 36 months.

The cohort included 102 Asian men, all with at least 36 months follow-up. In general there was good adherence to the use of the vacuum device (>50%) in the first 24 months, then it decreased. The erectile function recovery rate at 36 months post-treatment was 46.8% for the TCAP group and 65.5% for the HIFU group. Testosterone levels decreased for both treatments significantly across the 24 month follow-up period. There was no significant difference in the proportion of patients in either group with grade III or IV artificial erection during penile Doppler ultrasound. Changes in peak systolic velocity correlated with changes in IIEF-EF scores, but there were no significant differences in end diastolic velocity or resistance index after treatments. There were no significant reductions in penile length or circumference under flaccid or erect conditions following HIFU or TCAP at any post-treatment time point compared with baseline, nor were there differences between treatment groups.

Li LY, Lin Z, Yang M, Gao X, Xia TL, Ding T
J Sex Med. 2010 Mar 11. Epub ahead of print.

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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