Faure Walker Nicholas A, Norris Joseph M, Shah Taimur T, Yap Tet, Cathcart Paul, Moore Caroline M, Ahmed Hashim U, Emberton Mark, Minhas Suks
Department of Urology, Guys and St Thomas NHS Foundation Trust, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Urol Oncol. 2018 Feb;36(2):67-76. doi: 10.1016/j.urolonc.2017.12.002. Epub 2017 Dec 23.
To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF.
A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures.
Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures.
Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures for comparison. However, FT in general resulted in less effect on EF than WG ablation.
系统评价局限性前列腺癌初次全腺体（WG）和局部消融治疗后的勃起功能（EF）结果，以确定治疗方式或预期治疗体积是否会影响恢复至基线EF所需的时间。
根据系统评价和荟萃分析报告的首选项目进行系统评价。纳入标准为接受初次消融治疗的局限性前列腺癌男性患者。主要结局是通过客观、有效的症状评分测量恢复至基线EF。次要结局是磷酸二酯酶抑制剂或勃起辅助器具的使用。由于结局测量指标的异质性，未进行荟萃分析。
在2017年2月确定的222篇文章中，有55项研究报告了消融治疗后的EF，但只有17项使用了有效的结局测量指标并符合纳入标准。2项研究使用了WG冷冻疗法，5项使用了WG高强度聚焦超声（HIFU），2项使用了局部冷冻疗法，3项使用了局部HIFU，4项使用了局部光疗或激光治疗，3项使用了血管靶向光动力疗法，2项使用了不可逆电穿孔。WG冷冻疗法在6个月时与EF显著下降相关，36个月时改善甚微。接受局部HIFU治疗的患者在1个月时基线国际勃起功能指数-15（IIEF-15）下降30分，但在6个月时恢复至基线。其余局部治疗对EF显示出最小影响或无影响，但这些研究中的男性患者疾病病灶较小。该评价受到缺乏随机研究和结局测量指标异质性的限制。
大多数评估局部治疗对性功能结局的研究质量不高，使用了异质性结局，且随访时间相对较短，这突出表明需要采用更严格设计的研究，并使用经过验证的患者报告结局测量指标进行比较。然而，总体而言，局部治疗对EF的影响小于WG消融。
