There Is No Significant Difference Between On-Demand PDE5-I Vs. PDE5-I As Rehabilitative Treatment In Patients Treated By Bilateral Nerve-Sparing Radi

UroToday.com - Rehabilitative pharmacologic therapy has been promoted as a potentially useful, available approach to facilitate erection recovery following prostate cancer surgery. This study enrolled patients self-selecting to undergo proactive intervention following such surgery.

The main observation was that regular daily usage of the medication did not facilitate erection responses better than on-demand use (average 1.8 uses/week) nor did it lead to a higher rate of spontaneous erections, at a 12 month interval after surgery.

However, patients using some form of therapy did better than those electing no intervention. The main messages may well be that the interest and circumstances of the patient to recover erections factors heavily in the recovery of this function postoperatively and other interventions than PDE5-inhibitors remain needful for this clinical scenario.

Editor's note: Tens years ago this same group of ED experts in Italy identified that post-prostatectomy patients using alprostadil penile injections on a regular basis recovered natural erections at significantly higher rates than men undergoing similar surgery - who did not use regular alprostadil injections. This gave origin to the concept of 'penile rehabilitation' following radical prostatectomy. Clinical trials of oral phosphodiesterase type 5 inhibitors have shown significantly lower efficacies among post-prostatectomy men than age and risk matched controls. What we have learned from these trials is that normal erectile function does take some time to return, even in men who have had bilateral nerve sparing operations. Several studies have demonstrated efficacy of PDE5-inhibitors as long as 22-24 months following prostatectomy. So it is very reasonable for urologists to tell there patients that natural erectile responses can take 12-24 months to return after nerve-sparing prostatectomy. We should encourage them to periodically try PDE5-inhibitors. Unfortunately a true regimen of regular nightly dosing with these drugs has yet to be shown to statistically and reliably bring about return of erections sooner, despite all the theories of why they might be beneficial to erectile health. Many large clinical centers performing prostatectomy are instituting 'erectile rehabilitation or preservation trials' but for now the recommendation for use of any PDE5-inhibitor on a daily or routine regimen remains 'off label' advice.

AUA 2006 - Abstract 695

Reviewed by UroToday.com Contributing Editor Arthur Burnett

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