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Erectile Function Recovery After Focal Therapy Comparable Between Cryoablation and Irreversible Electroporation
Anthony Zhang, BS, George Tawfellos, MD, Louis Forgione, BS, Andrea Lopez-Sanmiguel, MD, Stanton Honig, MD, Preston C. Sprenkle, MD.
Yale University School of Medicine, New Haven, CT, USA.
Intro: Erectile function (EF) recovery is a major determinant of quality-of-life after focal therapy (FT) for localized prostate cancer. Cryoablation induces thermal injury, whereas irreversible electroporation (IRE) is a nonthermal modality that theoretically preserves surrounding neurovascular structures. We described EF recovery over 1 year after these FT modalities among men potent at baseline.
Methods: We retrospectively reviewed men undergoing primary subtotal FT (cryo and IRE) from 2014-2025. Subtotal FT was defined as <50% prostate ablation. Inclusion required intact baseline EF (Sexual Health Inventory for Men [SHIM]≥8) and baseline potency (SHIM question 2 ≥3). Potency recovery was defined as erection sufficient for penetration and assessed longitudinally. Cumulative recovery was evaluated through 12 months.
Results: 54 men met inclusion criteria (21 cryo and 33 IRE). Baseline SHIM trended higher in IRE (23 [IQR 16-25]) than cryo (18 [16-24]; p=0.064), while vascular comorbidities such as hypertension, diabetes, hyperlipidemia, smoking history, and phosphodiesterase-5 inhibitor (PDE5i) use at baseline were similar.Potency recovery increased over time and did not differ significantly between modalities at any interval. At 3-6 months, potency was observed in 58.3% of cryo and 57.1% of IRE patients. By 12 months, cumulative potency recovery was 68.8% for cryo and 70% for IRE. No statistically significant differences were observed between groups at any time point.
Conclusions: Among men potent at baseline, erectile function recovery following subtotal FT is substantial and comparable between cryoablation and IRE, with approximately 70% of patients regaining potency by 12 months within this cohort. These findings suggest FT modality selection may be guided by oncologic considerations rather than early functional outcomes.
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