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Detailing sexual outcomes after focal therapy for localised prostate cancer: a systematic review and meta-analysis

Fiard, Gaelle, Chowdhury, Aminah, Potter, Aneirin R., Pook, Celina J., Kelly, Daniel ORCID:, Emberton, Mark and Yap, Tet 2023. Detailing sexual outcomes after focal therapy for localised prostate cancer: a systematic review and meta-analysis. European Urology Focus 8 (4) , pp. 926-941. 10.1016/j.euf.2021.09.009

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Context Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. Objective We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research. Evidence acquisition A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the “litsearchr” function in R based on a preliminary “naïve” search using the following terms on Medline: ((“focal therapy” OR “focal treatment”) AND (“prostate cancer”) AND (“sexual function” OR “erectile function”)). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis. Evidence synthesis The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18–24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate −3.70 [95% confidence interval −4.43, −2.96]), with improvements at 6 mo (−2.18 [−2.91, −1.46]) and 12 mo (−2.14 [−2.96, −1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered. Conclusions Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Publisher: Elsevier
ISSN: 2405-4569
Date of First Compliant Deposit: 11 April 2023
Date of Acceptance: 10 September 2021
Last Modified: 11 Nov 2023 15:48

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