sildenafil-citrate and Prostatic-Neoplasms

Phosphodiesterase type-5 inhibitors (PDE5-Is) have been recommended as first line therapy for erectile dysfunction for patients received nerve-sparing radical prostatectomy for prostate cancer. We examed the efficiency of PDE5-Is and considered the optimal application. Systematic search of PubMed, Embase and the Cochrane Library was performed to identify all the studies. We identified 103 studies including 3175 patients, of which 14 were recruited for systematic review. Compared with placebo, PDE5-Is significantly ameliorated the International Index of Erectile Function-Erectile Function domain score (IIEF) scores (MD 4.89, 95% CI 4.25-5.53, p < 0.001). By network meta-analysis, sildenafil seems to be the most efficiency with a slightly higher rate of treatment-emergent adverse events (TEATs), whereas tadalafil had the lowest TEATs. In terms of IIEF scores, regular regimen was remarkably better than on-demand (MD 3.28, 95% CI 1.67-4.89, p < 0.001). Regular use was not associated with higher proportion of patients suffering TEATs compared with on-demand (RR 1.02, 95% CI 0.90-1.16, p = 0.72). Compared with placebo, PDE5-Is manifested significantly improved treatment outcomes. Overall, regular regimen demonstrated statistically pronounced better potency than on-demand. Coupled with the comparable rate of side effects, these findings support the regular delivery procedure to be a cost-effective option for patients.

Topics: Adolescent; Adult; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Network Meta-Analysis; Phosphodiesterase 5 Inhibitors; Prostatectomy; Prostatic Neoplasms; Sildenafil Citrate; Tadalafil; Treatment Outcome; Young Adult

Phosphodiesterase type 5 (PDE5) inhibitors have proved to be efficacious, safe, and well tolerated, in clinical trials and practice, for men with erectile dysfunction (ED). However, many patients are not satisfied with treatment and discontinue it prematurely. This review discusses evidence-based strategies that nurse practitioners (NPs) can use to improve diagnosis of ED, optimize patient outcomes, and identify opportunities to detect other potentially serious comorbid conditions.. This article was based on a previously published review, which involved a PubMed-MEDLINE search of the clinical literature from January 1, 1998 (year of sildenafil's approval in many markets), through August 30, 2008 (date of search).. Strategies to optimize responses to PDE5 therapy are summarized by the mnemonic "EPOCH": Evaluating and educating to ensure realistic expectations of therapy; Prescribing a treatment individualized to the couple's needs and preferences; Optimizing drug dose/regimen and revisiting key educational messages at follow-up visits; Controlling comorbidities via lifestyle counseling, medications, and/or referrals; and Helping patients and their partners to seek other forms of therapy if they have decided not to use a PDE5 inhibitor.. The "EPOCH" mnemonic may remind NPs of steps to optimize treatment outcomes with PDE5 inhibitors.

Topics: Adult; Aged; Cardiovascular Diseases; Depression; Educational Status; Health Status; Humans; Impotence, Vasculogenic; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Risk Factors; Sexuality; Sildenafil Citrate; Sulfones; Treatment Outcome

Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy.. We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords.. Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.

Topics: Brachytherapy; Erectile Dysfunction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Recovery of Function; Sildenafil Citrate; Sulfones

Cancer of the prostate (CAP) is one of the most common malignancies affecting North American men with about 215,000 new cases and 35,800 CAP related deaths annually. The most prevalent intervention for localized CAP is radical prostatectomy (RP) with 10-year survival rates approaching 90%. Studies of men in post-RP recovery indicate that 44% to 75% experience sexual dysfunction and more than 60% experience distress in reaction to sexual dysfunction problems. These findings are increasingly significant as prostate specific antigen testing continues to increase CAP detection rates, resulting in more and younger post-RP patients confronting sexual dysfunction.. A MEDLINE database search was performed for articles published from 1966 to September 2004.. Despite effectiveness 30% to 50% of patients who turn to sexually assistive aids after RP discontinue use within a year. This suggests that the achievement of physical responsiveness to an aid is necessary but it is not a sufficient factor in long-term sexual adaptation. Current research exploring this gap between effectiveness and ongoing use supports a broader perspective of sexual dysfunction emphasizing several factors, including perceptions of inadequacy, anxieties in regard to performance and depression in each member of the couple, overly enthusiastic expectations, partner physical/emotional readiness to resume active sex, the meaning to the couple of using a sexual aid and the quality of the nonsexual relationship of the couple.. Our findings reveal the need to explore broader strategies for improving patient coping ability and adaptation. They also point to the need to explore the role of resumed satisfying sexuality in overall quality of life following treatment.

Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Alprostadil; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Platelet Aggregation Inhibitors; Prevalence; Prostatectomy; Prostatic Neoplasms; Purines; Risk Factors; Sildenafil Citrate; Stress, Psychological; Sulfones; Vacuum Curettage

Development in the management of prostate cancer has placed increased attention on patient quality of life after treatment, particularly sexual function. The incidence of erectile dysfunction (ED) in men following radical prostatectomy has been estimated to range from 16% to 82%. Several factors determine the postoperative incidence of erectile difficulties; these include patient age, degree of cavernosal nerve sparing during surgery, cancer stage, and associated comorbidities. Early initiation of available treatments after radical prostatectomy, such as phosphodiesterase-5 (PDE-5) inhibitors and intracavernosal alprostadil, may improve the speed and degree of recovery of erectile function. Oral PDE-5 inhibitors are recognized as the first line of therapy for men with ED after radical prostatectomy, with reasonable success rates reported for all commercially available PDE-5 inhibitors. In recognition of the neurogenic basis for erectile dysfunction after radical prostatectomy, new strategies have been devised, such as cavernous nerve graft interposition procedures, perioperative neuroprotection measures, and postoperative neurotrophic treatments. Hopefully, these efforts will improve quality of life for patients with prostate cancer. The aim of this article is to review the current modalities of ED management for men with prostate cancer.

Topics: Adult; Brachytherapy; Combined Modality Therapy; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Penile Prosthesis; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Radiotherapy, Adjuvant; Risk Assessment; Severity of Illness Index; Sildenafil Citrate; Sulfones; Treatment Outcome

Although the high rate of erectile dysfunction (ED) following prostatectomy is well recognised, the aetiology and pathophysiology have not yet been fully elucidated. We examined the current literature as to aetiology, treatment and possible prevention of ED following prostatectomy.. Review of the literature by a Medline search.. The most important predictors of erectile function are pre-operative erectile function and the nerve sparing nature of the procedure. The former is determined by age and vascular risk-factors whereas the latter is decided by the stage of the tumour and the skill of the surgeon. The value of intraoperative nerve mapping seems limited and the importance of nerve grafting is uncertain. Natural recovery of erection can take as long as 24 months. Patients complain about a lack of professional support. Symptomatic therapy may be applied according to the current general standards of treatment in men with ED.

Topics: Alprostadil; Erectile Dysfunction; Humans; Male; Penile Erection; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Risk Factors; Sildenafil Citrate; Sulfones; Vacuum; Vasodilator Agents

Erectile dysfunction is a common sequela following potentially curative local treatment for early-stage carcinoma of the prostate gland. With larger studies and longer follow-up, it is clear that erectile dysfunction following prostate brachytherapy is more common than previously reported, with a myriad of previously unrecognized sexual symptoms. Approximately 50% of patients develop erectile dysfunction within 5 years of implantation. Several factors including preimplant potency, patient age, the use of supplemental external-beam irradiation, radiation dose to the prostate gland, radiation dose to the bulb of the penis, and diabetes mellitus appear to exacerbate brachytherapy-related erectile dysfunction. The majority of patients with brachytherapy-induced erectile dysfunction respond favorably to sildenafil citrate (Viagra). Despite reports questioning the potency-sparing advantage associated with brachytherapy, recent elucidations of brachytherapy-related erectile dysfunction may result in refinement of treatment techniques, an increased likelihood of potency preservation, and ultimately, improved quality of life.

Topics: Adult; Aged; Antineoplastic Agents, Hormonal; Brachytherapy; Erectile Dysfunction; Humans; Male; Middle Aged; Neoadjuvant Therapy; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Aged; Autonomic Nervous System; Erectile Dysfunction; Humans; Intraoperative Complications; Male; Middle Aged; Nerve Growth Factors; Nerve Regeneration; Penile Erection; Penis; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Sildenafil Citrate; Sulfones

To evaluate the long-term effect and safety of sildenafil citrate for the treatment of erectile dysfunction after radical prostatectomy (RP).. The study consisted of 91 patients with erectile dysfunction from our institution who received oral sildenafil citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of sildenafil citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS.. At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects.. The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adenocarcinoma; Adult; Aged; Cyclic Nucleotide Phosphodiesterases, Type 5; Drug Evaluation; Erectile Dysfunction; Follow-Up Studies; Health Surveys; Humans; Male; Middle Aged; Patient Dropouts; Patient Satisfaction; Penis; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Safety; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

Topics: Erectile Dysfunction; Humans; Male; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

Topics: Brachytherapy; Erectile Dysfunction; Humans; Male; Piperazines; Prostatic Neoplasms; Purines; Quality of Life; Radiotherapy Dosage; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Adult; Aged; Erectile Dysfunction; Humans; Incidence; Male; Middle Aged; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy; Radiotherapy, Computer-Assisted; Radiotherapy, Conformal; Radiotherapy, High-Energy; Sildenafil Citrate; Sulfones

Topics: Adrenergic alpha-Antagonists; Erectile Dysfunction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

Topics: Cardiovascular Diseases; Erectile Dysfunction; Family Practice; Health Promotion; Humans; Male; Men; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Suicide; Sulfones; United States

We evaluated the efficacy and safety of hyperbaric oxygenation therapy to preserve erectile function as part of penile rehabilitation after robot assisted bilateral nerve sparing radical prostatectomy for prostate cancer.. We performed a prospective, randomized, double-blind study from January 2009 to April 2013. Men 40 to 65 years old who underwent robot assisted bilateral nerve sparing radical prostatectomy were randomized 1:1 to the control or the treatment group. Participants were exposed to air as the control or to 100% oxygen as the treatment in hyperbaric conditions. The primary outcome was erectile function at 18 months as measured by IIEF (International Index of Erectile Function). Secondary outcomes were 12-month urinary symptoms, and 18-month sexual, urinary, bowel and hormonal related symptoms as measured by EPIC-26 (Expanded Prostate Index Composite-26). Adverse events and long-term cancer outcomes were monitored. Primary and secondary outcomes in the 2 groups were compared by the independent group t-test, the Wilcoxon rank sum test and the chi-square test of proportion.. A total of 109 potent men were randomized to hyperbaric oxygenation therapy or the control group. A total of 43 men in the air group and 40 in the hyperbaric oxygenation therapy group completed the 18-month followup. No statistically significant differences were observed between the 2 groups on any outcome measure.. This study revealed no difference in erectile recovery in men treated with hyperbaric oxygenation therapy vs placebo. Larger studies involving more diverse comorbidities and different hyperbaric oxygenation therapy regimens are needed to better evaluate the usefulness of hyperbaric oxygenation therapy for penile rehabilitation after radical prostatectomy.

Topics: Adult; Aged; Double-Blind Method; Erectile Dysfunction; Follow-Up Studies; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Penile Erection; Phosphodiesterase 5 Inhibitors; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Sildenafil Citrate; Time Factors; Treatment Outcome

It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this.. Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly assigned to receive sildenafil 100 mg regularly twice per week for 3 months immediately after urethral catheter removal as the early group or only 3 months after nerve sparing robot-assisted laparoscopic radical prostatectomy as the delayed group. The study primary end point was the full erectile function recovery rate, defined as an IIEF-5 score of 17 or greater, during the 12 months.. Of the 120 randomized patients the proportion who achieved full recovery was significantly higher during the 12 months in the early group than in the delayed group (β = 0.356, p <0.001, generalized estimating equation). After 9 months postoperatively the proportion of patients who achieved full recovery steadily increased to 41.4% at 12 months in the early group while patients in the delayed group showed no further improvement. Thus, full recovery was achieved in only 17.7% of patients at 12 months. Only early sildenafil treatment independently improved full recovery at 12 months (HR 2.943, p = 0.034).. Our trial provides clinical data to suggest that earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute to the recovery of erectile function after radical prostatectomy in the clinical setting.

Topics: Erectile Dysfunction; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Penile Erection; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Robotic Surgical Procedures; Sildenafil Citrate; Time Factors; Treatment Outcome

Multiple studies have evaluated the use of PDE5 inhibitors in penile rehabilitation following nerve-sparing prostatectomy. These studies have evaluated the use of various pharmacologic agents as well as various approaches to treatment (on-demand vs. rehabilitative). Most of these studies relied on self-reported outcomes to determine efficacy of the therapy which could allow response bias to affect their results. The aim of this study was to evaluate the effects of nightly sildenafil citrate therapy during penile rehabilitation, using nocturnal penile rigidity (RigiScan(™), Gotop Medical, Inc., St. Paul, MN, USA) in addition to the IIEF-EF. Patients with localized prostate cancer and normal erectile function prior to nsRP were randomized to take either nightly 50 mg sildenafil citrate or placebo starting the night following surgery. Both groups were allowed on-demand sildenafil citrate. Erectile function was evaluated at 2 weeks, 3, 6, 9 and 12 months post-operatively, with a final assessment made at 13 months, following a 1 month drug washout. At all time points, self-reported (IIEF-EF) and objective (RigiScan(™)) measures were obtained and evaluated. About 74 of 97 randomized patients completed the study. On completion, 40% of patients in each group had normal erectile function based on RigiScan(™) (p = 1.0). Additionally, no statistical differences were seen using the IIEF-EF domain (32.4% of placebo, 29% of treatment; p = 0.79). Multivariable analysis showed no significant differences in erectile function based on treatment intervention. Results did show that African-American men in this cohort were at higher risk for lower RigiScan(™) scores over time (OR: 0.48, p = 0.0399). This study demonstrates that nightly sildenafil citrate does not provide a therapeutic benefit for recovery of erectile function post-prostatectomy when compared to on-demand dosing using both self-reported as well as objective measures. Differences in objective recovery parameters based on patients' race/ethnicity warrant further investigation.

Topics: Double-Blind Method; Erectile Dysfunction; Humans; Male; Penile Erection; Phosphodiesterase 5 Inhibitors; Placebos; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Sildenafil Citrate

We studied adjuvant daily sildenafil citrate during and after radiotherapy for prostate cancer for erectile function preservation.. We performed a randomized, prospective trial of 279 patients with localized prostate cancer treated with radiotherapy who received sildenafil citrate (50 mg daily) or placebo (2:1 randomization). Medication/placebo was initiated 3 days before treatment and continued daily for 6 months. Before therapy and 3, 6, 9, 12, 18 and 24 months after radiotherapy patients completed the IIEF questionnaire, including the erectile function domain, the I-PSS questionnaire and the RAND SF-36®. All IIEF domains were scored.. At 12 months erectile function scores were better for sildenafil citrate than placebo (p = 0.018), 73% of patients on sildenafil citrate vs 50% on placebo had mild/no erectile dysfunction (p = 0.024) and the sildenafil citrate arm had superior overall satisfaction (p = 0.027) and IIEF total scores (p = 0.043). At 24 months erectile function and IIEF scores were no longer significantly better for sildenafil citrate (p = 0.172 and 0.09, respectively) and yet overall satisfaction scores were higher (p = 0.033). Sexual desire scores in patients who received sildenafil citrate were higher at 24 months although they had completed drug therapy 18 months previously (p = 0.049). At 24 months 81.6% of patients on sildenafil citrate and 56.0% of those on placebo achieved functional erection with or without erectile dysfunction medication (p = 0.045).. Daily sildenafil citrate during and after radiotherapy for prostate cancer was associated with improved overall sexual function compared with placebo for various sexual function domains. To our knowledge this is the largest randomized, prospective, controlled trial to show the usefulness of a phosphodiesterase-5 inhibitor as a rehabilitation strategy in patients with prostate cancer who received radiation therapy.

Topics: Aged; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Prospective Studies; Prostatic Neoplasms; Purines; Radiotherapy; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Time Factors

To clarify the role of phosphodiesterase type 5 (PDE5) inhibitors in post-prostatectomy penile rehabilitation (PPPR). To compare nightly and on-demand use of PDE5 inhibitors after nerve-sparing minimally invasive radical prostatectomy (RP).. We conducted a single-institution, double-blind, randomized controlled trial of nightly vs on-demand 50-mg sildenafil citrate after nerve-sparing minimally invasive RP. A total of 100 preoperatively potent men, aged <65 years, with scores on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) ≥26, underwent nerve-sparing surgery. The patients were randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose six tablets/month) for 12 months. Patients then underwent a 1-month washout period. Validated measures of erectile function (IIEF-EF score and the Expanded Prostate Cancer Index Composite [EPIC]) were compared between treatment groups over the entire 13-month time course, using multivariable mixed linear regression models.. The treatment groups were well matched preoperatively (mean age 54.3 vs 54.6 years, baseline IIEF-EF score 29.4 vs 29.3, for the nightly vs the on-demand sildenafil groups, respectively). No significant differences were found in erectile function between treatments (nightly vs on-demand sildenafil) at any single timepoint after RP, after adjusting for potential confounding factors. When evaluated over all timepoints simultaneously, no significant effects of treatment group (nightly vs on-demand sildenafil) were found on recovery of potency, as assessed by absolute IIEF-EF scores (P = 0.765), on percentage of men returning to an IIEF-EF score >21 (P = 0.830), or on IIEF-EF score recovery to a percentage of baseline value (P = 0.778). When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessment of potency (including EPIC item 59 response 'erections firm enough for intercourse'), attempted intercourse frequency or confidence.. Erectile recovery up to 1 year after RP does not differ between previously potent men who use sildenafil nightly compared to on-demand. This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally invasive RP.

Topics: Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Minimally Invasive Surgical Procedures; Penile Erection; Phosphodiesterase 5 Inhibitors; Piperazines; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Recovery of Function; Sildenafil Citrate; Sulfones; Treatment Outcome

Erectile dysfunction (ED) is a common adverse event associated with treatment for prostate cancer. This study aimed to identify whether early, regular use of sildenafil after radiation treatment for prostate cancer is effective at reducing the rate of ED at 2 years.. A randomised controlled trial with 27 men planned for radiation treatment for localised prostate cancer recruited from a single radiotherapy centre in Australia. Men were randomised to receive daily sildenafil, or a placebo tablet, for 6 months. The primary end-point was erectile function, as measured by the International Index of Erectile Function (IIEF) score, at 2-year follow-up. The abridged IIEF-5 survey was also used during the treatment period, and could be derived from the full IIEF at other time-points. Two-sided Student's t-tests and Mann-Whitney U-tests were used for the analysis of continuous outcomes, with Fisher's exact test for dichotomous outcomes.. No difference was seen at 2 years in the primary end-point, and IIEF scores did not differ significantly between groups during the study. Men in the sildenafil group exhibited significantly better IIEF-5 scores at 4 weeks (P = 0.02) and 6 months (P = 0.02). There was no difference in erectile function scores between the two groups throughout the treatment period. No significant difference in adverse events was identified between the two groups.. There was no evidence from this trial that sildenafil provides long-term erectile function for patients while on medication. Regular use of sildenafil may improve short-term sexual function for patients while on medication. Larger trials are required to examine the effectiveness of implementing sildenafil for prostate cancer patients undergoing radiation treatment.

Topics: Aged; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Placebo Effect; Prostatic Neoplasms; Purines; Radiation Injuries; Radiotherapy, Conformal; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Erectile dysfunction (ED) may be the most commonly observed adverse event (AE) associated with the combination of radiation therapy (RT) and androgen deprivation therapy (ADT). A significant number of men are trying phosphodiesterase type 5 inhibitors (PDE5s) such as sildenafil to treat ED, yet sildenafil studies to date shed little light on the response to ED after ADT.. The purpose of this trial was to evaluate sildenafil in the treatment of ED in prostate cancer patients previously treated with external beam RT and neoadjuvant and concurrent ADT..   In this randomized, double-blinded crossover trial, eligible patients received RT/ADT for intermediate risk prostate cancer and currently had ED as defined by the International Index of Erectile Function (IIEF). Patients were randomized to 12 weeks of sildenafil or placebo followed by 1 week of no treatment then 12 weeks of the alternative. Treatment differences were evaluated using a marginal model for binary crossover data.. The primary end point was improved erectile function, as measured by the IIEF.. The study accrued 115 patients and 61 (55%) completed all three IIEF assessments. Sildenafil effect was significant (P = 0.009) with a difference in probabilities of erectile response of 0.17 (95% confidence interval: 0.06, 0.29), and 0.21 (0.06, 0.38) for patients receiving ≤ 120 days of ADT. However, as few as 21% of patients had a treatment-specific response, only improving during sildenafil but not during the placebo phase.. This is the first controlled trial to suggest a positive sildenafil response for ED treatment in patients previously treated with RT/ADT, however, only a minority of patients responded to treatment. ADT duration may be associated with response and requires further study. The overall low response rate suggests the need for study of additional or preventative strategies for ED after RT/ADT for prostate cancer.

Topics: Aged; Aged, 80 and over; Androgens; Humans; Impotence, Vasculogenic; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy; Risk Assessment; Self Report; Sildenafil Citrate; Sulfones

Erectile dysfunction (ED) commonly affects the quality of life of men after treatment of prostate cancer. We conducted a placebo-controlled, crossover randomised trial to assess the efficacy and tolerability of sildenafil citrate in the treatment of ED developing after external beam radiation treatment (EBRT) of localized prostate cancer. Sixty-six patients who had developed ED following radiation treatment agreed to participate and were allocated to sildenafil or placebo to be taken prior to four sexual attempts. In the crossover period, subjects received the alternative tablet for a further four attempts. Allocation was centrally randomized, and researchers and patients were both blinded to the trial arm. Efficacy was assessed using the International Index of Erectile Function (IIEF) questionnaire and with a separate global efficacy question. Forty-three subjects completed the study. There was a significant increase in mean scores from baseline for all domains of the IIEF with sildenafil compared with placebo (P < 0.001). Affirmative response to the global efficacy question was more common after taking sildenafil compared with placebo. In approximately half of the patients, the improvement in the erectile function domain score corresponded to a moderate improvement in ED (e.g. success 'sometimes' to 'most times'). Sildenafil was associated with mild flushing, nasal stuffiness or indigestion in 8-10% patients and moderate flushing in 10%. The current study adds to the evidence that phosphodiesterase inhibitors are an effective and well-tolerated treatment for ED after EBRT for prostate cancer.

Topics: Aged; Combined Modality Therapy; Cross-Over Studies; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Placebo Effect; Prostatic Neoplasms; Purines; Radiotherapy, Conformal; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

After bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP), nocturnal and sexually mediated erections may help to preserve normal erectile function (EF).. To investigate nocturnal penile tumescence and rigidity (NPTR) in a subset (N = 54 men) from a randomized, double-blind trial (N = 76) of nightly sildenafil after BNSRRP.. Inclusion required preoperative "normal" EF (defined as a combined score of >/=8 for International Index of Erectile Function questions 3 (penetration) and 4 (maintained erection after penetration) and NPTR testing (>/=10 continuous minutes of >/=55% rigidity [R >/= 55%] at the base). Postoperative assessments were at weeks 4 (pretreatment), 16, 28, 40 (during 36 weeks of nightly prophylaxis: sildenafil 50 mg [N = 17], 100 mg [N = 18] or placebo [N = 19]), and 48 (after 8 weeks of no erectile dysfunction therapy, when "responders" were delineated by the defined normal EF and a "yes" response to "Over the past 4 weeks, have your erections been good enough for satisfactory sexual activity?"). Base and tip rigidity and tumescence were measured using penile plethysmography.. Duration of R >/= 55% and area under the curves for rigidity and tumescence.. Postoperatively, rapid profound reduction in nocturnal EF was noted in all groups. There was a gradual dose-dependent improvement in base and tip rigidity in the sildenafil groups but little improvement in the placebo group. Eight weeks after treatment termination (48 weeks postoperatively), 24% (4/17) of 50-mg sildenafil recipients, 33% (6/18) of 100-mg sildenafil recipients, and 5% (1/19) of placebo recipients were responders. Tip R >/= 55% was the most discriminating NPTR measure between nonresponders and responders to sildenafil, in whom it regained baseline (preoperative) levels (whereas base R >/= 55% did not). It was most prolonged in responders to sildenafil 100 mg.. In our subset analysis, nightly sildenafil for 9 months post-BNSRRP objectively improved nocturnal erections and pharmaceutically unassisted EF.

Topics: Adult; Aged; Area Under Curve; Dose-Response Relationship, Drug; Double-Blind Method; Erectile Dysfunction; Humans; Longitudinal Studies; Male; Middle Aged; Minimally Invasive Surgical Procedures; Patient Satisfaction; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Time Factors; Treatment Outcome

To evaluate the effect of low-dose sildenafil for rehabilitating erectile function after nerve-sparing radical prostatectomy (NSRP), as the delay to recovery of erectile function after NSRP remains under debate.. Forty-three sexually active patients had a NSRP; at 7-14 days after surgery they had a Rigiscan (Dacomed Corporation, Minneapolis, MN, USA) measurement of nocturnal penile tumescence and rigidity (NPTR). To support the recovery of spontaneous erectile function, 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night. A control group of 18 patients were then followed but had no phosphodiesterase-5 inhibitors. The International Index of Erectile Function (IIEF)-5 questionnaire was completed 6, 12, 24, 36 and 52 weeks after NSRP.. Of the 43 patients, 41 (95%) had one to five erections during the first night after catheter removal. In the group using daily sildenafil the mean IIEF-5 score decreased from 20.8 before NSRP to 3.6, 3.8, 5.9, 9.6 and 14.1 at 6, 12, 24, 36 and 52 weeks after NSRP, respectively. In the control group the respective scores were 21.2, decreasing to 2.4, 3.8, 5.3, 6.4 and 9.3. There was a significant difference in IIEF-5 score and time to recovery of erectile function between the groups (P < 0.001), with potency rates of 86% vs 66%.. The measurement of NPTR after NSRP showed erectile function even the 'first' night after catheter removal. In cases of early penile erection, daily low-dose sildenafil leads to a significant improvement in the recovery of erectile function.

Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Erection; Penis; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Recovery of Function; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

We prospectively investigated whether postoperative statin use would contribute to earlier recovery of erectile function in men who underwent bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer.. A total of 50 potent men without hypercholesterolemia undergoing bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer were prospectively randomized into 2 equal groups. Group 1 patients were instructed to ingest only 50 mg sildenafil per day if needed following hospital discharge after radical retropubic prostatectomy. Group 2 patients were prescribed atorvastatin at a dose of 10 mg daily from postoperative days 1 to 90 and they were also instructed to ingest sildenafil, as in group 1. Patient status regarding potency and adverse events were assessed 6 months after surgery.. The 2 groups demonstrated no significant differences regarding various baseline factors, including International Index of Erectile Function-5 scores. Group 2 had a significantly higher postoperative International Index of Erectile Function-5 score than group 1 at 6 months postoperatively (p = 0.003). Meanwhile, as judged by a preset definition, the incidence of potent patients 6 months after prostatectomy was 26.1% in group 1 and 55% in group 2 (p = 0.068). Also, 17.4% and 40% of the men reported achieving intercourse by vaginal penetration without a phosphodiesterase 5 inhibitor in groups 1 and 2, respectively (p = 0.172). No serious adverse events associated with medication were reported.. Postoperative treatment with atorvastatin in men who report normal erectile function preoperatively may contribute to earlier recovery of erectile function after nerve sparing radical retropubic prostatectomy.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Aged; Atorvastatin; Cyclic Nucleotide Phosphodiesterases, Type 5; Denervation; Drug Therapy, Combination; Erectile Dysfunction; Follow-Up Studies; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Microsurgery; Middle Aged; Penile Erection; Peripheral Nerves; Piperazines; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Pyrroles; Sildenafil Citrate; Sulfones; Vasodilator Agents

Erectile dysfunction is a recognized complication of radiation therapy for prostate cancer. Sildenafil citrate is a well-known management strategy for erectile dysfunction that has been found to be efficacious across a wide spectrum of comorbidities, including post-radiation erectile dysfunction. We defined the efficacy of sildenafil citrate in patients with erectile dysfunction following radiation therapy for prostate cancer and assessed the impact of the interval after radiation on the success of this therapy.. Baseline and followup data on 110 patients presenting with erectile dysfunction secondary to radiation for prostate cancer was obtained. A total of 68 patients underwent 3-dimensional conformal external beam irradiation (CRT), while 42 underwent brachytherapy (BT) without androgen deprivation. All patients were considered to have erectile dysfunction after radiotherapy, as assessed by the International Index of Erectile Function (IIEF), and they were prescribed sildenafil citrate. Mean time +/- SD between the completion of radiation therapy and the initiation of sildenafil was 8 +/- 4 months. The response to sildenafil was assessed using the IIEF questionnaire. Within and between group comparisons were done for 3 time points, that is less than 12, 13 to 24 and 25 to 36 months following the completion of radiation therapy.. The respective response rates in men who underwent BT/CRT at the 3 time points of less than 12, 13 to 24 and 25 to 36 months was 76%/68%, 54%/46% and 44%/38%, respectively. Mean IIEF erectile function domain scores for these 3 time points after BT/CRT was 26/23, 22/19 and 17/15, respectively. The percent of patients who achieved normalization of the IIEF erectile function domain at the 3 time points in the BT/CRT groups was 60%/50%, 48%/42% and 26%/19%, respectively.. Sildenafil citrate improves erectile function in men in whom erectile dysfunction develops following radiation therapy for prostate cancer. There is a clear time dependence for the response to this therapy with a stepwise decrease in all end points examined serially in a 3-year period.

Topics: Aged; Brachytherapy; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostatic Neoplasms; Purines; Radiotherapy, Conformal; Sildenafil Citrate; Sulfones; Time Factors

It has been suggested that postradical prostatectomy (RP) erectile function outcomes are improved by early use of erectogenic medications. This analysis was designed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function.. Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil. Nonresponders were switched to intracavernosal injection therapy (ICI). Patients were instructed to inject three times a week. Only patients who presented within 6 months post RP, who completed the International Index of Erectile Function (IIEF) questionnaire on at least three separate occasions after surgery, and who had been followed for at least 18 months were included. Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP.. There were 58 patients in the rehabilitation (R) group and 74 in the nonrehabilitation (NR) group. No differences existed in mean patient age, comorbidity profile, intraoperative nerve sparing status, or postoperative erectile hemodynamics between the two groups. At 18 months post RP, there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse (R=52% vs. NR=19%, P<0.001); mean erectile rigidity (R=53+/-21% vs. NR=26+/-43%, P<0.01); mean IIEF erectile function (EF) domain scores (R=22+/-6 vs. NR=12+/-14, P<0.01); the percentage of patients with normal EF domain scores (R=22% vs. NR=6%, P<0.01); the percentage of patients responding to sildenafil (R=64% vs. NR=24%, P<0.001); the time to become a sildenafil responder (R=9+/-4 vs. NR=13+/-3 months, P=0.02); and the percentage of patients responding to ICI (R=95% vs. NR=76%, P<0.01).. The data generated from this nonrandomized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP.

Topics: Clinical Protocols; Coitus; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Time Factors

We undertook to determine if any significant differences in the efficacy of sildenafil citrate for erectile dysfunction (ED) exists between patients who have received external beam radiation or brachytherapy for prostate cancer.. Thirty-one patients who had received external beam radiation and nineteen patients who had received brachytherapy for prostate cancer and were subsequently treated with sildenafil citrate for post-irradiation ED comprised the patient population. A chart analysis was performed to determine either the presence or absence of concomitant risk factors for ED (coronary artery disease, diabetes, hypertension and smoking history) as well as age at radiation and time lapse between radiation completion and sildenafil citrate administration. Patients were then contacted to ascertain sildenafil citrate efficacy (defined as the continued use of sildenafil citrate), dosage used and medication tolerance.. Continued use of sildenafil citrate was reported by 12/19 (63%) of the brachytherapy patients and 7/31 (22%) of the external beam radiation patients, a significant difference (P<0.007). Of those with continued use of sildenafil citrate, the patients who had undergone external beam radiation had a longer mean period of use (33.7 months) than those who had been treated with brachytherapy (14.3 months) (P=0.006). The mean elapsed time between completion of radiation and administration of sildenafil citrate was 7.6 months and 21.6 months for the brachytherapy and external beam radiation patients respectively (P=0.002). A significant difference in mean age existed between the patient groups, with the external beam radiation group being significantly older (69.8 years and 65.1 years respectively, P=0.007) at the time of sildenafil citrate administration. Of the risk factors for ED examined in each patient group, none were found to predict treatment failure with sildenafil citrate. Of the patients who did not experience success with sildenafil citrate, both groups used the medication for comparable periods of time.. Sildenafil citrate improved ED in a significantly greater number of patients who had undergone brachytherapy over those who had received external beam radiation. However, the patients who had received external beam radiation were both older and experienced a longer lapse of time between completion of radiotherapy and administration of sildenafil citrate than the brachytherapy patient group. This may explain the poorer success in the external beam radiation patients. The success of sildenafil in both groups of patients was lower than has previously been reported.

Topics: Age Factors; Aged; Brachytherapy; Erectile Dysfunction; Humans; Male; Piperazines; Prostatic Neoplasms; Purines; Radiation Injuries; Risk Factors; Sildenafil Citrate; Sulfones; Vasodilator Agents

To determine the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer.. Sixty patients treated with radiotherapy for prostate cancer at least 6 months previously, complaining of erectile dysfunction, and not using nitrates were entered into a double-blind, placebo-controlled, crossover study lasting 12 weeks. They received 50 mg of sildenafil or placebo for 2 weeks; at week 2, the dose was increased to 100 mg in the case of an unsatisfactory erectile response. At week 6, patients crossed over to the alternative treatment. Patients were then allowed to enter a 6-week open-label phase using 50 mg of sildenafil in the first 2 weeks, increasing the dose to 100 mg in the case of an insufficient erectile response in the following 4 weeks. Data were collected before trial entry (baseline evaluation) and every 2 or 4 weeks using the International Index of Erectile Function questionnaire. Any side effects were recorded. Two years later, all patients were approached by mail to evaluate their current sexual functioning and possible use of sildenafil.. All patients completed the double-blind, crossover study. For nearly all the International Index of Erectile Function questions, sildenafil caused a significant increase in mean scores from baseline. Placebo had no effect. Seventy-seven percent entered the open-label phase; they were the better responders in the double-blind phase. Sildenafil was as equally effective as in the double-blind phase. The side effects were mild or moderate and significantly decreased in the open-label period. Two years after trial entry, 24% still used sildenafil.. Sildenafil is relatively effective in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer. New drugs and combination therapies are needed to improve outcome.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adenocarcinoma; Aged; Cross-Over Studies; Cyclic Nucleotide Phosphodiesterases, Type 5; Double-Blind Method; Drug Evaluation; Erectile Dysfunction; Follow-Up Studies; Health Surveys; Humans; Male; Middle Aged; Patient Satisfaction; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Prostatic Neoplasms; Purines; Radiation Injuries; Radiotherapy, Conformal; Safety; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

To determine the efficacy of sildenafil in patients with erectile dysfunction after external beam radiotherapy for prostate cancer.. Randomised, double-blind, placebo-controlled, crossover study.. A total of 406 patients with erectile dysfunction reported in their medical records who had completed external beam radiotherapy at least 6 months prior to the study, were approached by letter. Sixty patients were included in a study which lasted 12 weeks. They received 50 mg of sildenafil citrate or placebo for two weeks; during week 2 the dose could be increased to 100 mg in the case of unsatisfactory erectile response. At week 6 patients crossed over to the alternative treatment. Data were collected using the validated 'International index of erectile function' (IIEF) questionnaire, and side-effects were recorded. Patients were given the possibility of continuing to a 6-week open-label phase.. The mean age of those participating was 68 years. All patients completed the double-blind phase. For the majority f questions in the IIEF questionnaire, there was a significant increase in mean scores from baseline with sildenafil, but of the patients with sildenafil, versus 18% with placebo. Ninety percent of the patients required a dose adjustment to 100 mg sildenafil, and 100% of the patients in the placebo group increased the dose. Side-effects were mild or moderate. Patients who proceeded to the open-label phase reported the same results as in the double-blind phase.. Sildenafil improved erectile function in about half of the patients with erectile dysfunction after external beam radiotherapy for prostate cancer, and it was well tolerated.

Topics: Aged; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Prostatic Neoplasms; Purines; Radiation Injuries; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

To assess the long-term sexual potency and attrition in sexual function after iodine-125 ((125)I) seed radiotherapy and the effect of sildenafil on radiation-induced erectile dysfunction (ED).. This prospective study consisted of 86 sexually active patients (mean age 63.5 +/- 7.7 years) who underwent (125)I seed implantation from 1997 to 1999 to treat low-volume prostate cancer (prostate-specific antigen less than 10 ng/mL, Gleason score 6 or less, stage T1-T2). All patients were followed up every 6 to 8 months for 4 years. Patients prescribed sildenafil citrate for ED completed the abridged five-item version of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires.. The median follow-up was 49.7 months (range 36 to 66). Of 86 patients, 43 (50%) did not initiate drug therapy; and only 36 (83.7%) of the 43 were interviewed at 4 years. Twenty-three (63.8%) of the 36 patients had erections sufficient for vaginal penetration, with a total mean +/- SD IIEF-5 score of 15.76 +/- 1.13. The other 50% (43 of 86) initiated sildenafil citrate for treatment of ED after seed implantation, with a minimal follow-up of 6 months. At 4 years, 32 (74%) of the 43 were responding positively to sildenafil citrate, with a total IIEF-5 score of 18.3 +/- 1.2. The mean EDITS +/- SD score was 76.5 +/- 3.2, and the spousal satisfaction rate was 72% (31 of 43). The dropout rate was 37% (16 of 43); 10 (63%) of the 16 discontinued because of a lack of efficacy, 3 (19%) because of a return of natural erections sufficient for vaginal penetration, and 3 (19%) discontinued because of side effects (headaches).. ED is a major long-term issue after (125)I seed radiotherapy, with a long-term potency rate of 29%. Sildenafil citrate improves erections in most patients after (125)I seed implantation.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Brachytherapy; Erectile Dysfunction; Follow-Up Studies; Headache; Humans; Iodine Radioisotopes; Male; Middle Aged; Patient Satisfaction; Piperazines; Prospective Studies; Prostatic Neoplasms; Purines; Severity of Illness Index; Sexual Partners; Sildenafil Citrate; Sulfones; Vasodilator Agents

We evaluated the response of sildenafil citrate in patients with prostate cancer treated with three-dimensional conformal radiation therapy (3DCRT) whose sexual function (SF) was known prior to therapy initiation.. From March 1996 to April 1999, 24 men with median age of 68 years (range 51 to 77) had 3DCRT for localized prostate cancer (median prescribed dose to the planning target volume of 70.2 Gy). These men started taking sildenafil for relief of sexual dysfunction at a median time of 1 year after completing 3DCRT. We used the self-administered O'Leary Brief Sexual Function Inventory to evaluate in series SF and overall satisfaction at three time points. These points were (a) before initiation of all therapies (3DCRT or hormonal treatment [HT]) for prostate cancer, (b) before starting sildenafil (50 mg or 100 mg) but after completion of all therapies, and (c) at least 2 months afterward. Rates of SF were based on the number of men responding to a given question. We tested for significance of these two interventions to change SF by applying the Wilcoxon sign rank test.. Prior to all treatments, 20 (87%) of 23 men were sexually potent, with 8 (36%) of 22 fully potent (little or no difficulty for penetration at intercourse). After 3DCRT with or without HT and prior to sildenafil use, 13 (65%) of the 20 potent patients remained potent, with only 2 (11%) of 19 being fully potent. The use of sildenafil citrate resulted in 21 (91%) of 23 men being potent, with 7 (30%) being fully potent. In 16 men responding to the satisfaction question, 10 (63%) and 12 (75%) were mixed to very satisfied with their sex life before 3DCRT with or without HT and after sildenafil citrate use, respectively. This response corresponded to potency and satisfaction scores significantly decreasing and subsequently increasing on average by one unit after 3DCRT and sildenafil citrate use, respectively (P <0.05).. In men receiving 3DCRT for prostate cancer, these data indicate that sildenafil citrate is effective for restoring SF and associated satisfaction back to baseline before treatment.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy, Conformal; Sildenafil Citrate; Sulfones

To determine the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy (3D-CRT) for prostate cancer.. 406 patients with complaints of erectile dysfunction and who completed radiation at least 6 months before the study were approached by mail. 3D-CRT had been delivered (mean dose 68 Gy). Sixty patients were included and entered a double-blind, placebo-controlled, cross-over study lasting 12 weeks. They received during 2 weeks 50 mg of sildenafil or placebo; at Week 2 the dose was increased to 100 mg in case of unsatisfactory erectile response. At Week 6, patients crossed over to the alternative treatment. Data were collected using the International Index of Erectile Function (IIEF) questionnaire, and side effects were recorded.. Mean age was 68 years. All patients completed the study. For most questions of the IIEF questionnaire there was a significant increase in mean scores from baseline with sildenafil, but not with placebo. Ninety percent of the patients needed a dose adjustment to 100 mg sildenafil. Side effects were mild or moderate.. Sildenafil is well tolerated and effective in improving erectile function of patients with ED after 3D-CRT for prostate cancer.

Topics: Aged; Cross-Over Studies; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy; Sildenafil Citrate; Sulfones

To determine the efficacy of sildenafil for patients with erectile dysfunction after radiotherapy for localized prostate cancer.. Fifty patients with erectile dysfunction after radiotherapy were treated with sildenafil. Their median age was 68 years (range 54 to 78). All were treated with a three-dimensional conformal external beam radiotherapy approach, and the median dose prescribed to the planning target volume was 75.6 Gy. Patients were initially given 50 mg of sildenafil and instructed to use the medication on at least three occasions. They were then contacted to ascertain the efficacy of and tolerance to the medication.. Significant improvement in the firmness of the erection after sildenafil was reported in 37 patients (74%), 2 (4%) had partial improvement, and 11 (22%) had no response. Significant improvement in the durability of the erection was reported in 33 patients (66%), 3 (6%) had partial improvement, and 14 (28%) reported no improvement. Patients with partial or moderate erectile function before using sildenafil were more likely to benefit from the medication compared with those with absent function. Among 29 patients with erections classified as partial after radiotherapy, 26 (90%) had a significant response to the medication. In contrast, only 11 (52%) of 21 with erections classified as flaccid after radiotherapy had a significant response to the medication (P = 0.007).. Sildenafil improved erectile function in greater than two thirds of patients with postradiotherapy impotence. Patients with less severe dysfunction are most likely to benefit from this intervention.

Topics: Administration, Oral; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy; Sildenafil Citrate; Sulfones

To ascertain the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction (ED) either before or after prostate brachytherapy by an open-label, nonrandomized study.. Sixty-two patients who underwent prostate brachytherapy between March 1995 and July 1998, had ED either before or after brachytherapy, and were interested in treatment with sildenafil comprised the patient population. Clinical and treatment parameters evaluated for medication efficacy included patient age at brachytherapy and at medication administration, hypertension, diabetes, smoking history, onset of ED, potency status before implant, frequency of intercourse before brachytherapy (if potent), use of neoadjuvant hormonal manipulation, use of moderate dose external beam radiation therapy before implantation, choice of isotope, V100 (the percentage of the prostate volume receiving at least 100% of the prescribed minimal peripheral dose), and sildenafil dose.. Fifty (80.6%) of 62 patients responded favorably to sildenafil. None of the treatment parameters predicted medication failure, and among the clinical parameters, only diabetes predicted failure (3 of 5) and only with borderline statistical validity (P = 0.046).. Our results suggest brachytherapy-induced impotence is as amenable to sildenafil treatment as ED from other causes. In addition, our 80.6% success rate is comparable to reported results for patients who underwent bilateral nerve-sparing radical prostatectomy and significantly better than patients who underwent unilateral nerve-sparing or non-nerve-sparing approaches.

Topics: Adenocarcinoma; Aged; Brachytherapy; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

To determine the response to sildenafil citrate (Viagra) in patients with erectile dysfunction after radiation therapy for localized prostate cancer.. Baseline and follow-up data from 21 patients presenting with erectile dysfunction after radiation treatment for clinical T1-2 prostate cancer were obtained. Two patients had undergone iodine-125 seed implantation and the remaining 19 conformal external beam irradiation. All 21 patients were considered to have erectile dysfunction as assessed by the International Index of Erectile Function (IIEF) and were prescribed sildenafil at a dosage of 50 mg, with a titration to 100 mg if needed. The mean time between the completion of radiation therapy and initiation of sildenafil was 24.6 +/- 5.8 months. The quality of the erectile function was assessed after a minimum of four doses by using the Cleveland Clinic Erectile Function (CCEF) questionnaire and the IIEF questionnaire. A positive response to sildenafil on the CCEF questionnaire was defined as an erection sufficient for vaginal penetration. The responses on the IIEF questionnaire were rated on a scale of 1 (almost never) to 5 (almost always), with 0 being no sexual activity.. On the CCEF questionnaire, 71% (15 of 21) of patients had a positive response, with a mean duration of 12.7 +/- 2.5 minutes of intercourse, and a corresponding spousal satisfaction rate of 71%. Twelve (80%) of the 15 responders required titration to the 100-mg dosage for maximal effect. The most common side effects seen were transient flushing (19%), abnormal color vision (14%), and headaches (10%). No patient discontinued the drug because of side effects. On the IIEF questionnaire, the responses to questions 3 (frequency of penetration), 4 (maintenance of erection), 7 (satisfactory intercourse), and 15 (erection confidence) increased from mean baseline scores of 1.3, 1.1, 1.2, and 1.8 to final mean scores of 4.0, 3.9, 3.2, and 3.4, respectively (P <0.001). On the global efficacy question (ability to achieve firm erections), 71% of the patients responded positively.. Sildenafil citrate can improve the ability to achieve and maintain an erection in most patients with erectile dysfunction after radiation therapy for prostate cancer.

Topics: Aged; Erectile Dysfunction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Radiotherapy; Sildenafil Citrate; Sulfones; Surveys and Questionnaires

Erectile dysfunction is a common late complication patients may experience after external-beam radiotherapy for prostate cancer. The efficacy and safety of oral sildenafil to correct sexual dysfunction caused by external-beam radiotherapy was studied in patients participating in our prospective trial.. Thirty-five assessable patients participated in this prospective pilot study. Using a 25-point scale based on the International Index of Sexual Function, erectile dysfunction was assessed weekly, during which time patients received sildenafil 100 mg orally once a week for 6 consecutive weeks. Response was defined as a score of 18 or more, corresponding to at least one successful attempt at sexual intercourse per week.. Thirty patients (86%) completed the 6-week study. Seventy-seven percent of these patients had significantly improved erectile function, allowing recovery of full capacity for sexual intercourse. Of 27 patients not receiving concomitant hormone treatment, failure to respond was observed in only four patients (15%) compared with four (50%) of eight patients receiving hormonal treatment during the study. The time course of response was gradual, with 40%, 57%, 66%, 69%, and 74% responding at weeks 1 through 5, respectively. Therapy was generally well tolerated. The most frequently reported side effects in patients were flushing (37%), transient headache (17%), and dyspepsia (9%). No patient reported priapism, and no cardiovascular event or death was observed. After response, 12 patients (34%) reported the ability to achieve and maintain an erection sufficient for intercourse in the absence of sildenafil (ie, 24 hours to 6 days after taking the medication).. This study suggests that oral sildenafil is well tolerated and can reverse erectile dysfunction after radiotherapy in a substantial proportion of prostate cancer patients.

Topics: Adult; Aged; Comorbidity; Erectile Dysfunction; Humans; Male; Middle Aged; Pilot Projects; Piperazines; Prostatic Neoplasms; Purines; Radiation Injuries; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

Androgen-deprivation therapy (ADT) is the primary systemic therapy for treating advanced or metastatic prostate cancer (PCa), which has improved survival outcomes in patients with PCa. However, ADT may develop metabolic and cardiovascular adverse events that impact the quality of life and lifespan in PCa survivors. The present study was designed to establish a murine model of ADT with a gonadotropin-releasing hormone (GnRH) agonist leuprolide and to investigate its effects on metabolism and cardiac function. We also examined the potential cardioprotective role of sildenafil (inhibitor of phosphodiesterase 5) under chronic ADT. Middle-aged male C57BL/6J mice received a 12-wk subcutaneous infusion via osmotic minipumps containing either saline or 18 mg/4 wk leuprolide with or without 1.3 mg/4 wk sildenafil cotreatment. Compared with saline controls, leuprolide treatment significantly reduced prostate weight and serum testosterone levels, confirming chemical castration in these mice. The ADT-induced chemical castration was not affected by sildenafil. Leuprolide significantly increased the weight of abdominal fat after 12-wk treatment without a change in total body weight, and sildenafil did not block the proadipogenic effect of leuprolide. No signs of left ventricular systolic and diastolic dysfunction were observed throughout the leuprolide treatment period. Interestingly, leuprolide treatment significantly elevated serum levels of cardiac troponin I (cTn-I), a biomarker of cardiac injury, and sildenafil did not abolish this effect. We conclude that long-term ADT with leuprolide increases abdominal adiposity and cardiac injury biomarker without cardiac contractile dysfunction. Sildenafil did not prevent ADT-associated adverse changes.

Topics: Adiposity; Androgen Antagonists; Androgens; Animals; Gonadotropin-Releasing Hormone; Heart Diseases; Humans; Leuprolide; Male; Mice; Mice, Inbred C57BL; Prostatic Neoplasms; Quality of Life; Sildenafil Citrate

Phosphodiesterase type 5 inhibitors represent the standard treatment of erectile dysfunction after nerve-sparing prostatectomy. Avanafil is a second-generation phosphodiesterase type 5 inhibitor with a high selectivity for phosphodiesterase type 5 isoform. To date, there are no studies comparing the outcomes of avanafil versus sildenafil in this scenario. In this study, we evaluated the efficacy and safety of avanafil versus sildenafil as a drug for post-prostatectomy rehabilitation. Overall, 160 patients submitted to robot-assisted nerve-sparing prostatectomy for localized prostate cancer at three hospitals were enrolled for the present study. After 6 months of treatment, patients in the two groups showed no significantly different sexual function scores, except for the Erection Hardness Score and Sexual Encounter Profile-Q2 that were higher in the Sildenafil group. Adverse events in the Avanafil group occurred in four (5%) patients and in 16 (20%) patients in the Sildenafil group. According to our experience, in patients undergoing nerve-sparing prostatectomy, penile rehabilitation with avanafil compared to sildenafil showed a lower ability to produce a valid erection in the initial phase of sexual intercourse, a difference that disappears in the continuation of the same. Avanafil showed a greater tolerance profile with a lower rate of AEs and discontinuation of therapy due to AEs.

Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Organ Sparing Treatments; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Pyrimidines; Robotic Surgical Procedures; Sildenafil Citrate; Treatment Outcome

We previously reported that Sildenafil enhances apoptosis and antitumor efficacy of doxorubicin (DOX) while attenuating its cardiotoxic effect in prostate cancer. In the present study, we investigated the mechanism by which sildenafil sensitizes DOX in killing of prostate cancer (PCa) cells, DU145. The death receptor Fas (APO-1 or CD95) induces apoptosis in many carcinoma cells, which is negatively regulated by anti-apoptotic molecules such as FLIP (Fas-associated death domain (FADD) interleukin-1-converting enzyme (FLICE)-like inhibitory protein). Co-treatment of PCa cells with sildenafil and DOX for 48 hours showed reduced expression of both long and short forms of FLIP (FLIP-L and -S) as compared to individual drug treatment. Over-expression of FLIP-s with an adenoviral vector attentuated the enhanced cell-killing effect of DOX and sildenafil. Colony formation assays also confirmed that FLIP-S over-expression inhibited the DOX and sildenafil-induced synergistic killing effect as compared to the cells infected with an empty vector. Moreover, siRNA knock-down of CD95 abolished the effect of sildenafil in enhancing DOX lethality in cells, but had no effect on cell killing after treatment with a single agent. Sildenafil co-treatment with DOX inhibited DOX-induced NF-κB activity by reducing phosphorylation of IκB and nuclear translocation of the p65 subunit, in addition to down regulation of FAP-1 (Fas associated phosphatase-1, a known inhibitor of CD95-mediated apoptosis) expression. This data provides evidence that the CD95 is a key regulator of sildenafil and DOX mediated enhanced cell death in prostate cancer.

Topics: Antibiotics, Antineoplastic; Apoptosis; Blotting, Western; Cell Proliferation; Doxorubicin; Drug Resistance, Neoplasm; Drug Synergism; fas Receptor; Fluorescent Antibody Technique; Humans; Male; Prostatic Neoplasms; Signal Transduction; Sildenafil Citrate; Tumor Cells, Cultured; Urological Agents

To investigate the efficacy of tamsulosin monotherapy and tamsulosin with low-dose sildenafil combination therapy on lower urinary tract symptoms (LUTS) following low-dose-rate (LDR) brachytherapy in early prostate cancer patients.. From March 2008 to June 2014, of the 212 prostate cancer patients with a Gleason score ≤7 who received LDR brachytherapy, 80 patients with a prostate volume ≤35 g and progressed LUTS following implantation were selected. All 80 patients took tamsulosin 0.4-mg monotherapy until 1 month after implantation. Then, the patients were divided into two groups; 45 patients received tamsulosin 0.4-mg monotherapy, and 35 patients received tamsulosin 0.4-mg plus sildenafil 25-mg combination therapy due to erectile dysfunction. LUTS were compared between the two groups using the International Prostate Symptom Score (IPSS), the mean maximum flow rate (Q max) and the pre-implantation post-voiding residual (PVR) volume at 1 and 3 months after implantation.. The pre-implantation total IPSS, Q max and PVR for the monotherapy and combination therapy groups were 14.0 ± 6.7, 14.3 ± 3.2 ml/s and 36.3 ± 16.7 ml and 15.3 ± 5.6, 13.7 ± 4.5 ml/s and 39.0 ± 23.4 ml, respectively. At 1 month post-implantation, both groups showed increases in total IPSS and PVR, but no statistically significant differences were observed (P = 0.078, P = 0.23). At 3 months post-implantation, the combination therapy group showed a greater decrease in total IPSS compared with the monotherapy group (P = 0.035), but there were no statistically significant differences in the Q max and PVR between the two groups.. Tamsulosin plus low-dose sildenafil combination therapy is a beneficial treatment for post-implantation progression of LUTS.

Topics: Adrenergic alpha-Antagonists; Aged; Brachytherapy; Drug Therapy, Combination; Humans; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Prospective Studies; Prostatic Neoplasms; Radiotherapy Dosage; Sildenafil Citrate; Sulfonamides; Tamsulosin; Treatment Outcome

Patients with recurrent ischemic priapism have historically been treated with anti-androgen therapy due to the limited available evidence for more targeted therapies to treat the underlying pathophysiologic mechanisms of this condition. We report a case in which anti-androgen therapy caused significant adverse side effects and likely masked this patient's elevated prostate-specific antigen (PSA) levels, which adversely impacted the timely diagnosis and treatment of his prostate cancer.. A 69-year-old man treated with anti-androgens for priapism initially developed unwanted anti-androgenic side effects such as gynecomastia, erectile dysfunction, and decreased libido. After decreasing his anti-androgen dosage and starting a specified regimen of phosphodiesterase type 5 inhibitor therapy, his serum PSA levels were found to be elevated. He was subsequently diagnosed with adenocarcinoma of the prostate and underwent a radical prostatectomy with the pathologic finding of high-grade, locally progressive disease.. Anti-androgen therapy carries significant complication risks, including the potential to alter the diagnosis and treatment of prostate cancer. Clinicians administering this therapy for priapism management should be aware of these possible risks.

Topics: Adenocarcinoma; Aged; Androgen Antagonists; Anilides; Delayed Diagnosis; Humans; Male; Nitriles; Phosphodiesterase 5 Inhibitors; Piperazines; Priapism; Prostate-Specific Antigen; Prostatic Neoplasms; Purines; Secondary Prevention; Sildenafil Citrate; Sulfones; Tosyl Compounds

The Radiation Therapy Oncology Group (RTOG) 0215 investigated the efficacy of sildenafil in improving erectile dysfunction following radiotherapy and neoadjuvant/concurrent androgen deprivation therapy among prostate cancer patients and found a significant improvement on drug but only in 21% of study participants. This paper reports on a secondary aim to investigate the effect of sildenafil on overall sexual and marital adjustment among both patients and their wives.. RTOG 0215 was a placebo-controlled, double-blind, crossover trial of sildenafil. Participation of wives was optional. Twenty-four married heterosexual couples (33% of heterosexual couples in study) completed the Sexual Adjustment Questionnaire and Locke's Marital Adjustment Test. Treatment differences in mean change scores were evaluated by paired t-tests, and the proportion of patients achieving a clinically meaningful change was evaluated using chi-square tests. Spearman's correlation coefficients were used to determine the association of adjustment between patients and wives.. There was no significant change in either sexual or marital adjustment for patients. For wives, there was a trend for improvement in sexual adjustment but no significant change in marital adjustment. Change in marital adjustment between patients and wives was weakly related (r(s) = 0.15, p = 0.48), and for sexual adjustment, there was a moderate, but nonsignificant relationship (r(s) = 0.40, p = 0.09).. Larger studies are warranted to further examine possible differences in sexual experiences and treatment needs between prostate cancer patients and their wives, as well as to assess predictors of sildenafil response.

Topics: Aged; Aged, 80 and over; Androgen Antagonists; Combined Modality Therapy; Cross-Over Studies; Double-Blind Method; Erectile Dysfunction; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Spouses; Statistics, Nonparametric; Sulfones; Surveys and Questionnaires; Treatment Outcome

Chronic inflammation, recruitment of myeloid-derived cells, and perturbation of the arginine metabolism have been all proposed as mechanisms favoring prostate carcinogenesis and tumor immunoescape. Objective of this study was to evaluate whether accumulation of CD11b(+)Gr1(+) cells, also defined myeloid-derived suppressor cells, occur in mice affected by transplantable or spontaneous prostate cancer (PC). We also investigated whether N(G) nitro-L-arginine methyl ester (L-NAME) and sildenafil, both modulators of the arginine metabolism, restrain tumor growth and restore tumor-specific immunity.. Wild-type C57BL/6 mice bearing TRAMP-C1 PC and transgenic adenocarcinoma of the mouse prostate (TRAMP) mice were treated with vehicle, L-NAME or sildenafil, and evaluated for CD11b(+) cells accumulation in the blood, several organs, and the tumor mass and for disease progression.. CD11b(+)Gr1(high), CD11b(+)Gr1(int), and CD11b(+)Gr1(-) cells differently accumulated in different organs and especially in the tumor of the two mouse models. L-NAME and sildenafil impaired the immunosuppressive function of CD11b(+) cells in both models and restrained TRAMP-C1 growth, but they neither break tumor-specific immune tolerance nor limit tumor progression in TRAMP mice.. Collectively, our results emphasize substantial differences in tumor-induced alteration of myelopoiesis and sensitivity to modulators of the arginine metabolism between a transplantable and a spontaneous model of PC. They also suggest that perturbation of the arginine metabolism is dispensable for PC progression and the associated T-cell tolerance.

Topics: Adenocarcinoma; Animals; Arginine; CD11b Antigen; Cell Proliferation; Disease Progression; Immune Tolerance; Male; Mice; Mice, Inbred C57BL; Mice, Transgenic; Myelopoiesis; NG-Nitroarginine Methyl Ester; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; T-Lymphocytes; Tumor Cells, Cultured

To define if erectile function (EF) outcomes were better in men with early institution of penile rehabilitation after radical prostatectomy (RP), as one of the mechanisms by which patients fail to recover EF after RP is collagenization of corporal smooth muscle with subsequent venous leak development, and rehabilitation is aimed at preventing these structural alterations.. The study population comprised patients who: (i) had clinically organ-confined prostate cancer; (ii) had fully functional erections, corroborated by the partner; (iii) had bilateral nerve-sparing RP; and (iv) committed to pharmacological penile rehabilitation. Patients completed the International Index of Erectile Function (IIEF) serially after RP. Patients were instructed to obtain three erections/week using initially sildenafil, and if unsuccessful, then intracavernous injections. Patients were subdivided into those starting rehabilitation at < 6 months after RP (early) and those starting at > or = 6 months after RP (delayed).. There were 48 patients in the early group and 36 in the delayed group; patients in both groups were matched for age, comorbidity status and baseline EF. The mean duration after RP at the time of starting penile rehabilitation was 2 and 7 months in the early and delayed groups, respectively (P < 0.01). At 2 years after surgery there was a highly statistically significant difference in IIEF EF domain score between the early and delayed groups (22 vs 16, P < 0.001). There were also statistically significant differences between the groups in the percentage of men at 2 years after RP who had unassisted functional erections and sildenafil-assisted functional erections (58% vs 30%, P < 0.01; 86% vs 45%, P < 0.01, respectively).. These data suggest that delaying the start of penile rehabilitation after RP is associated with poorer outcomes for EF.

Topics: Humans; Impotence, Vasculogenic; Male; Middle Aged; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Time Factors; Treatment Outcome

Therapy (case series).. 4.. To evaluate factors that affect compliance in men who enroll in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome.. We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for > or =2 months.. The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing.. The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP.

Topics: Carbolines; Erectile Dysfunction; Humans; Male; Medication Adherence; Middle Aged; Patient Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Purines; Robotics; Sildenafil Citrate; Sulfones; Tadalafil; Trauma, Nervous System; Treatment Outcome

To examine the early use of phosphodiesterase-5 inhibitor (PDE-5i; sildenafil citrate) in preventing subsequent erectile dysfunction (ED) after (monotherapy) prostate brachytherapy (PB, an accepted option for Gleason 6 or low-volume Gleason 7 prostate cancer), as PB is currently being offered more frequently in younger patients, and ED can be a side-effect often within the first 12 months after treatment.. We examined a single-surgeon series of 69 patients who had been treated with PB from 2002 to 2005. All patients had a follow-up of ≥ 1 year; prospectively, and patients had baseline, 6- and 12-month assessments using the Sexual Health Inventory for Men (SHIM) and International Index of Erectile Function (IIEF)-6 scores. The 69 patients were divided into early treatment with PDE-5i (31) and not treated with PDE-5i (38), and their SHIM and IIEF-6 scores were compared at baseline, 6 and 12 months. Daily sildenafil (25-50 mg) was given immediately after PB for 12 months. Overall, for the entire group, the mean prostate-specific antigen (PSA) level was 6.8 ng/mL; 78% had Gleason 6 cancer and 20% had Gleason 7 (3 + 4) cancer. The mean age in the early PDE-5i group was 64.8 years, and was 66.0 years in the no-PDE-5i group. The mean radiation dose in the early PDE-5i group was 50.2 Gy, and 43.9 Gy in the other group (P= 0.08).. In the no-PDE-5i group, the mean baseline SHIM score of 17.1 decreased rapidly to 9.1 at 6 months (P= 0.01) and stayed at 9.3 at 12 months (P= 0.01). In the early PDE-5i group, the mean baseline SHIM score of 21.8 decreased slightly to 17.6 at 6 months (P= 0.2), and was maintained at 17.9 at 12 months (P= 0.2). Using the Wilcoxon rank-sum test, the 6- and 12-month SHIM scores in the two groups (P < 0.001). The IIEF-6 questionnaire confirmed the SHIM analysis.. After PB patients had a significant decline in SHIM/IIEF-6 scores at 6 and 12 months. Our results indicate a 50% decrease in the quality of their erections. This provides an opportunity to initiate early intervention with PDE-5i or perhaps vacuum constriction devices or intraurethral alprostadil. In this study, the early use of PDE-5i after PB maintained erectile function at both 6 and 12 months.

Topics: Aged; Brachytherapy; Epidemiologic Methods; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome

We have shown that the potent phosphodiesterase-5 (PDE-5) inhibitor sildenafil (Viagra) induces a powerful effect on reduction of infarct size following ischemia/reperfusion injury and improvement of left ventricular dysfunction in the failing heart after myocardial infarction or doxorubicin (DOX) treatment. In the present study, we further investigated the potential effects of sildenafil on improving antitumor efficacy of DOX in prostate cancer. Cotreatment with sildenafil enhanced DOX-induced apoptosis in PC-3 and DU145 prostate cancer cells, which was mediated by enhanced generation of reactive oxygen species, up-regulation of caspase-3 and caspase-9 activities, reduced expression of Bcl-xL, and phosphorylation of Bad. Overexpression of Bcl-xL or dominant negative caspase 9 attenuated the synergistic effect of sildenafil and DOX on prostate cancer cell killing. Furthermore, treatment with sildenafil and DOX in mice bearing prostate tumor xenografts resulted in significant inhibition of tumor growth. The reduced tumor size was associated with amplified apoptotic cell death and increased expression of activated caspase 3. Doppler echocardiography showed that sildenafil treatment ameliorated DOX-induced left ventricular dysfunction. In conclusion, these results provide provocative evidence that sildenafil is both a powerful sensitizer of DOX-induced killing of prostate cancer while providing concurrent cardioprotective benefit.

Topics: Animals; Antineoplastic Agents; bcl-Associated Death Protein; bcl-X Protein; Caspase 3; Caspase 9; Doxorubicin; Drug Synergism; Echocardiography, Doppler; Heart; Humans; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Neoplasm Transplantation; Phosphodiesterase Inhibitors; Phosphorylation; Piperazines; Prostatic Neoplasms; Purines; Reactive Oxygen Species; Sildenafil Citrate; Sulfones

Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED).. To define the predictors of sildenafil response in men treated with RT for prostate cancer.. International Index of Erectile Function (IIEF).. Patients were enrolled prospectively if they met the following criteria: (i) either a three-dimensional conformal external beam (EBRT) or brachytherapy (BT) with or without androgen deprivation (AD) for prostate cancer; (ii) self-reported ability to have sexual intercourse prior to RT; (iii) experienced onset of ED following RT; (iv) candidates for sildenafil citrate use; (v) followed-up periodically; and (vi) completed the IIEF at least 12 months after RT. Failure to respond to sildenafil was defined as IIEF-erectile function (EF) domain score of <22.. One hundred fifty-two patients met all the criteria: 110 in the EBRT group and 42 in the BT group. Mean age was 62 years. The mean follow-up was 38 months. Mean radiation dose for EBRT was 78 Gy and for BT was 101 Gy. Thirty-five patients received AD, 25% of EBRT, and 62% of BT patients. Sixty-one percent of the patients receiving AD had exposure only pre-RT, whereas 39% had pre- and post-RT AD exposure. The mean duration of AD was 4.6 months. Post-RT IIEF-EF domain score at >24 months was 17. Successful response to sildenafil occurred in 68% of men at 12 months after RT, 50% at 24 months, and 36% at 36 months. On multivariable analysis, predictors of failure to respond to sildenafil were: older age, longer time after RT, AD > 4 months duration, and RT dose > 85 Gy. Modality of radiation delivery was not predictive of sildenafil failure.. A steady decrease in sildenafil response was seen with increasing duration after RT. Several factors were predictive of sildenafil failure.

Topics: Dose-Response Relationship, Radiation; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostatic Neoplasms; Purines; Radiotherapy Dosage; Severity of Illness Index; Sildenafil Citrate; Sulfones; Time Factors

It has been suggested that the institution of a pharmacologically based penile rehabilitation program in the early stages after radical prostatectomy (RP) may benefit some patients.. This analysis was conducted to define if predictors of successful outcome with pharmacological penile rehabilitation following RP could be identified.. Retrospective statistical analysis was performed on a large database of patients who had participated in a post-RP rehabilitation program. Inclusion criteria included: presence of functional erections permitting sexual intercourse pre-RP and commencement of rehabilitation within 12 months of RP. Patients were instructed to obtain a penetration-rigidity erection on at least three occasions per week and to continue this regimen until at least 18 months after RP using either sildenafil or intracavernosal injection therapy (if oral therapy failed).. International Index of Erectile Function (IIEF) and visual analog scale erectile rigidity assessment. Stepwise logistic regression analysis was used to generate predictors of erectile function (EF) outcomes with penile rehabilitation.. Ninety-two patients constituted the study population. Mean patient age and duration post-RP at commencement of the rehabilitation program were 59 +/- 10 years and 7 +/- 3 months, respectively. Sixty-seven percent of operations were bilateral nerve sparing (BNS), 11% unilateral nerve sparing (NS), and 22% non-NS. Comorbidities included hypertension 22%, dyslipidemia 30%, coronary artery disease 7%, and diabetes 2%. Preoperative mean self-reported, partner-corroborated erectile rigidity during relations was 90 +/- 20%. At 18 months post-RP, 57% patients had partner-corroborated functional erections without phosphodiesterase type 5 inhibitors with a mean erectile rigidity during relations of 72 +/- 16% compared with 45 +/- 22% for those who denied functional erections postoperatively (P > 0.01). The IIEF-EF domain scores in these two cohorts were 21 +/- 7.5 and 13 +/- 9, respectively (P > 0.01). On multivariate analysis, factors that predicted failure of return of natural erections after RP having followed a rehabilitation program were age >60 years (relative risk [RR] = 1.3), non-BNS surgery (RR = 1.6), presence of >1 vascular comorbidity (RR = 2.1), commencement of rehabilitation >6 months post-RP (RR = 2.8), unsuccessful response to sildenafil at 12 months post-RP (RR = 4.5), and the use of trimix dose >50 units (RR = 8.1).. More than half of the patients committing to a pharmacological rehabilitation program had return of functional natural erections. Predictors of successful outcome included NS surgery, early post-RP presentation, young age, and absence of vascular comorbidities.

Topics: Health Status Indicators; Humans; Impotence, Vasculogenic; Logistic Models; Male; Middle Aged; Multivariate Analysis; Penis; Phosphodiesterase Inhibitors; Piperazines; Prognosis; Prostatectomy; Prostatic Neoplasms; Purines; Retrospective Studies; Risk Factors; Sildenafil Citrate; Sulfones; Treatment Outcome

To define haemodynamic changes after radical retropubic prostatectomy (RP) and the predictive value of these for the outcome of erectile function (EF), as although there are predictors of the recovery of EF, penile vascular changes might also affect the recovery of EF.. Prospective data were analysed from men who had RP followed by duplex penile Doppler ultrasonography (DUS) within 6 months of RP. All men had functional erections before RP, based on self-report and partner corroboration, and all completed the International Index of Erectile Function (IIEF) questionnaire serially after RP. The EF, based on IIEF scores, was then correlated with the penile DUS results.. In all, the study included 111 patients; 32 (29%) had normal erectile haemodynamics after RP, while 79 (71%) had abnormal haemodynamics. Twelve patients (11%) had a venous leak. There were no differences in mean patient age or comorbidity profile between those with and without haemodynamic changes. Comparing those with normal and abnormal haemodynamics, the mean IIEF EF domain scores were 25 and 17 (P = 0.025), the percentages of erectile rigidity at 18 months was 66% vs 35% (P = 0.013), the percentage of patients with normal EF domain scores was 28% vs 6% (P < 0.01), the percentage of patients with functional erections permitting sexual intercourse unassisted by pharmacological agents was 47% vs 22% (P = 0.018), and the percentage of patients responding to sildenafil citrate, as defined by vaginal penetration, was 72% vs 43% (P = 0.03), respectively.. The results of this prospective study indicate that a patient's penile vascular status is correlated with their EF after RP.

Topics: Erectile Dysfunction; Hemodynamics; Humans; Male; Middle Aged; Patient Satisfaction; Penile Erection; Penis; Phosphodiesterase Inhibitors; Piperazines; Prognosis; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome; Ultrasonography, Doppler, Duplex

Assess acceptance of and discontinuation rate from erectile dysfunction (ED) treatment in patients after bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP).. We analyzed acceptance and discontinuation data of 100 consecutive, age-comparable, preoperatively self-reported potent BNSRRP patients who at the discharge from the hospital received a phosphodiesterase type 5 inhibitor (PDE5-I) prescription. Patients were informed of the pharmacokinetic properties of the available compounds and the option of on-demand versus rehabilitative therapy. Thereafter, patients did not receive any specific counseling throughout the entire follow-up period and freely decided to use or not use any ED therapy. Complete preoperative data were obtained on hospital admission and included a medical and sexual history and the International Index of Erectile Function (IIEF). The IIEF was completed every 6 mo postoperatively, and patients participated in a semi-structured interview about the treatment adherence at the 18-mo follow-up.. Forty-nine (49%) patients freely decided not to start any ED therapy (group 1). Of the remaining patients, 36 (36%) opted for an as-needed PDE5-I (group 2), whereas 15 (15%) decided to use a daily PDE5-I (group 3). At the 18-mo follow-up, the overall discontinuation rate from both treatment modalities was 72.6% (eg, 72.2% vs. 73.3% in group 2 vs. group 3; p=0.79). Treatment effect below expectations was the main reason for treatment discontinuation, followed by loss of interest in sex due to partner's causes.. Almost 50% of BNSRRP patients freely decided not to start any ED treatment postoperatively. Roughly 73% of patients who started therapy eventually discontinued it.

Topics: Carbolines; Erectile Dysfunction; Follow-Up Studies; Humans; Imidazoles; Male; Middle Aged; Patient Compliance; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Tadalafil; Time Factors; Treatment Outcome; Treatment Refusal; Triazines; Vardenafil Dihydrochloride

Topics: Amlodipine; Antihypertensive Agents; Disease Progression; Dose-Response Relationship, Drug; Drug Interactions; Erectile Dysfunction; Humans; Hypertension; Male; Middle Aged; Optic Nerve; Optic Neuropathy, Ischemic; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Retinal Artery; Risk Factors; Sildenafil Citrate; Sulfones; Time; Vision, Low

Topics: Actins; Adrenergic alpha-Antagonists; Aged; Animals; Blotting, Western; Cyclic GMP; Cyclic GMP-Dependent Protein Kinases; Doxazosin; Humans; Immunohistochemistry; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

The aim of this study was to evaluate sexual functions (SF) of patients after retropubic, non-nerve-sparing radical prostatectomy (NNS-RP).. A self-assessment survey on 213 selected patients (multiple choice questionnaire, 18 questions and 80 choices with regard to pre- and postoperative SF and course of tumor disease) was performed. The analysed parameters were demographics, sexual desire, capacities for erections and intercourses, orgasm, use of potency-supporting drugs and devices, attending physicians, life quality (LQ), and S100 immunohistochemical staining on neurovasculare bundles (NVB).. The general response rate of the survey was 61.5 %. 123 data files were evaluable. 87 % of the patients reported on pre-operative erections (n = 107). Of these 12.1 % (n = 13) noticed residual nocturnal erections after NNS-RP. One patient had additional arbitrary full-erections that enabeled him to practice intercourse (< 50 % of attempts sufficient). Bilateral resections of NVB were confirmed on all histopathological specimens from erectile patients. Although 59.2 % of the patients reported on sexual desires (71/120) that persisted postoperatively, only 53.3 % (38/71) tested drugs or devices to induce or improve erections. 18 of these 38 patients (47.4 %) were finally capable of intercourses. 9 of 123 patients were sildenafil-responders, eight of them without any spontaneous erections. 23.8 % of the patients reported on a severe decrease in quality of life due to complete or partial loss of SF. However, only 62.6 % patients (77/123) asked for professional support regarding SF. For this purpose 88.3 % (68/77) consulted an urologist.. The existence of residual spontaneous erectile activities and responses on sildenafil after NNS-RP indicate some kind of functional accessory routes for innervations besides the NVB (or submaximal resections). However, the prevalence and quality of the observed erections were clinically insignificant.

Topics: Age Factors; Aged; Cohort Studies; Coitus; Data Collection; Erectile Dysfunction; Humans; Immunohistochemistry; Male; Middle Aged; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Retrospective Studies; Sexuality; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

Radiation therapy is a widely accepted strategy for prostate cancer. Erectile dysfunction is a common complication of radiation therapy. Adjuvant androgen deprivation was shown to prolong survival in select patients. There is controversy regarding the impact of androgen deprivation on erectile function. We defined the impact of androgen deprivation on the sildenafil response in patients with erectile dysfunction following radiation therapy.. Patients were enrolled prospectively if they underwent radiation therapy in the form of 3-dimensional conformal external beam or brachytherapy with or without androgen deprivation, reported functional erections before radiation therapy, experienced the onset of erectile dysfunction following the completion of radiation therapy, had comprehensive erectile dysfunction evaluation, including a thorough history and physical examination, attempted sildenafil periodically and completed the International Index of Erectile Function on at least 2 occasions throughout the first 3 years following the completion of radiation therapy.. A total of 152 patients were enrolled. Mean age +/- SD was 62 +/- 14 years. No significant difference existed in age or radiation dose between patients with and without androgen deprivation exposure. Mean androgen deprivation duration was 3.8 +/- 1.8 months. For patients with conformal external beam and brachytherapy the sildenafil response, mean erectile function domain score and percent who experienced erectile function domain normalization at each time point were lower in those with vs without androgen deprivation.. Androgen deprivation seems to exert a deleterious effect on erectile function in men undergoing radiation therapy for prostate cancer. This was observed in men treated with conformal external beam and brachytherapy at short-term, medium term and long-term followup.

Topics: Aged; Androgen Antagonists; Brachytherapy; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Penis; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Purines; Radiotherapy, Conformal; Risk Assessment; Sildenafil Citrate; Statistics, Nonparametric; Sulfones; Treatment Outcome

To examine the relationship of 'symptom flare' with sexual function and lower urinary tract symptoms (LUTS) before brachytherapy, as we noted that after brachytherapy for prostate cancer, some patients had recurrent LUTS after an asymptomatic period; this secondary exacerbation of symptoms ('symptom flare') occurred at approximately 2 years after implantation and was transient in most patients.. In all, 854 patients with organ-confined prostate carcinoma had transrectal ultrasonography-guided transperineal 125I interstitial brachytherapy of the prostate gland between June 1991 and September 2002, and were considered candidates for this study. Detailed information on urinary function was self-administered and prospectively collected before treatment and at intervals using the International Prostate Symptom Score (IPSS). Sexual function was evaluated with the Sexual Health Inventory for Men (SHIM), a five-question, self-administered diagnostic test that can help to indicate the presence or absence of erectile dysfunction (ED). We used previously established criteria to estimate the risk of prostate-specific antigen (PSA) failure by dividing the men into three risk groups, i.e. low-risk, with a PSA level of < or = 10 ng/mL, stage < or = T2a, Gleason < or = 6; medium-risk, with a PSA level of < or = 15 ng/mL, Gleason 7 or stage T2b; and high-risk, with a PSA level of > 15 ng/mL, stage > T2b, or Gleason > or = 8.. There was a significant association of flare with ED; men with flare reported significantly more ED than men without (P = 0.020). Men with high-risk disease reported more ED because they received more intensive treatment (hormones and increased radiation dose) than men with medium- or low-risk disease. To correct for this confounding factor, multivariate linear regression was used; the regression was significant overall (P < 0.001), and the effects of risk group (P < 0.001) and flare (P < 0.026) on SHIM score were significant and independent of each other. Flare was also significantly associated with a higher pre-implant IPSS; the probability of flare was 62% for a pre-implant IPSS of zero, to 94% for an IPSS of 30.. Radiation reaction and radiation sensitivity contribute to ED and greater LUTS in men who have had brachytherapy for prostate cancer. This contribution is evident, e.g. in men with ataxia-telangiectasia (ATM) gene mutations. Sequence variants in the ATM gene, particularly those that encode for an amino-acid substitution, are associated with adverse radiotherapy responses among patients treated with 125I prostate brachytherapy. Our finding of the association of urinary symptom flare with ED suggests it would be worthwhile to determine whether sildenafil is as effective in men with flare, and if not, whether higher sildenafil doses would be of value. Alternatively, alpha1-selective adrenoceptor-blocking agents, e.g. terazosin, combined with sildenafil, might be of benefit. Also, patients with a high IPSS before brachytherapy can be warned that they have a greater risk of flare and ED.

Topics: Aged; Brachytherapy; Erectile Dysfunction; Humans; Male; Mutation; Piperazines; Prostatic Neoplasms; Prostatism; Purines; Quality of Life; Radiation Tolerance; Recurrence; Risk Factors; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

To investigate whether the early use of phosphodiesterase inhibitors (PDEIs) after brachytherapy (BT) is associated with better erectile function, as of men potent before BT 38-70% have erectile dysfunction afterward.. We evaluated a prospectively created database of 2500 patients who had had BT at our institution since 1992. We measured baseline age, cancer stage, Gleason grade, prostate specific antigen (PSA) level at diagnosis, implant type, use of neoadjuvant and adjuvant hormonal suppression therapy, use of external beam radiotherapy in conjunction with interstitial therapy, and follow-up PSA levels. Men were stratified by their use of PDEIs at <1 year (early group) or >1 year after implantation (late group). We excluded all men who did not have baseline Sexual Health Inventory for Men (SHIM) scores and at least one follow-up SHIM score; the latter were obtained at 6-month intervals after BT. Data were analysed using the Mann-Whitney U-test.. In all, 210 men met the inclusion criteria; 85 began using PDEIs within a year of BT, and 125 started after a year. The mean time to PDEI use was 191 days in the early and 595 days in the late group. The median age was 62 years in the early and 63 years in the late group (P = 0.02). Baseline Gleason scores did not differ, nor did PSA levels between the groups. Of men in the early group, 48% received neoadjuvant and/or adjuvant hormonal suppression therapy, vs half of men in the late group. Baseline SHIM scores were not significantly different, nor were scores at the first two follow-up assessments, but the scores at 18-36 months after BT were significantly different.. The early use of PDEIs after BT is associated with a significant improvement in and maintenance of erectile function compared with late use. Men undergoing BT should be encouraged to use PDEIs early after implantation, to preserve erectile function.

Topics: Brachytherapy; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Time Factors; Treatment Outcome

To assess the response rate to different erectile aids in a consecutive series of patients treated with non-nerve sparing radical prostatectomy (NNSRP).. Ninety-four potent men were counselled about the different treatment options to restore an assisted erection before they had NNSRP. They were invited to participate in a multiphase protocol involving the sequential use of different erectile aids which aimed at restoring erectile function after surgery. The first proposed treatment was oral apomorphine sublingual. Patients with a positive response to the 1-item overall efficacy question and a minimum score of 3 in both question 3 and 4 of the International Index of Erectile Function were considered responders to oral pharmacotherapy. Treatment with sildenafil was then suggested to those not responding. If patients did not respond to oral pharmacotherapy a trial with a vacuum erectile device was offered; those not responding to this were then offered intracavernosal injection therapy with prostaglandin-E alone as the first option, followed by a mixture of vasoactive agents if needed. In those in whom injections also failed, a penile implant was recommended. At the 1-year follow-up visit all patients were offered a second trial with oral therapy regardless of the treatment currently in use.. Seventy-six patients entered the protocol; there was no response to apomorphine. Five of 59 (8%) patients responded to sildenafil when they first used it at a mean of 7 months after NNSRP, while there were three additional responders in 22 patients who tried it for a second time a year later. Of patients achieving at least a complete tumescence sufficient for vaginal penetration, 52% and 60% were considered responders to the vacuum device and intracavernosal injections, respectively. Overall, 44% of patients enrolled in the protocol chose to use an erectile aid for at-home use. At the 1-year follow-up, only 20% of patients were still using an erectile aid, including two who had had a penile implant.. Up to 10% of patients may achieve a clinically significant erection with sildenafil after NNSRP, but 80% will not be using any erectile aid at 1 year after surgery. In the present study protocol the proposed erectile aids were largely inadequate for treating the permanent erectile dysfunction that follows NNSRP.

Topics: Administration, Sublingual; Aged; Algorithms; Apomorphine; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Patient Compliance; Penile Prosthesis; Piperazines; Postoperative Complications; Prospective Studies; Prostaglandins E; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vacuum; Vasodilator Agents

To report experience with combined therapy using intracorporal injection (ICI) of alprostadil and oral phosphodiesterase 5 (PDE-5) inhibitors for the minimally invasive treatment of erectile dysfunction (ED) after radical prostatectomy (RP), as PDE-5 inhibitors are effective but a few patients may have a suboptimal response.. In a retrospective study, 34 men (aged 46-66 years) had a nerve-sparing retropubic RP and subsequent ED. Patients were titrated on sildenafil citrate or vardenafil to maximum doses. All had a suboptimal response after a maximum of eight doses of oral therapy and were then treated with ICI therapy using 15 or 20 microg alprostadil. Erectile function was assessed with the Sexual Health Inventory for Men (SHIM).. Of the 32 patients who continued combined therapy, 22 (68%) had an improvement in erectile function after ICI therapy, as assessed by the SHIM score. On follow-up, 36% of these patients used ICI therapy only intermittently, instead of regularly, as they felt that this was adequate enough for good results.. PDE-5 oral pharmacotherapy is the most commonly used effective therapy for ED but may not be as effective in patients who have radical surgery; the addition of testosterone patches may have side-effects or be considered a risk in patients with a history of prostate cancer. The use of ICI therapy as an adjunct or maintenance therapy to their oral medication may be another alternative in these patients.

Topics: Administration, Oral; Aged; Alprostadil; Drug Therapy, Combination; Humans; Imidazoles; Impotence, Vasculogenic; Injections; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Postoperative Care; Prostatectomy; Prostatic Neoplasms; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents

To present a pilot study of laparoscopic unilateral sural nerve grafting during radical prostatectomy, with the aim of preserving sexual potency.. Because they had localized prostate cancer, 29 men had a laparoscopic radical prostatectomy with deliberate wide unilateral neurovascular bundle resection and preservation of the contralateral bundle. Fifteen men (group A) had an interposition sural nerve graft on the sectioned bundle, and 14 (group B) had laparoscopic radical prostatectomy with preservation of the unilateral bundle only. The men were also involved in a rehabilitation programme, and erectile function was evaluated after surgery, and at 3, 8, 12 and 18 months, using the five-item version of the International Index of Erectile Function (IIEF-5) questionnaire.. The two groups had similar clinical characteristics (age, prostate-specific antigen level, body mass index, prostate volume, clinical stage, Gleason score before and after surgery, postoperative stage). The follow-up was complete for 12 men in group A and 10 in group B. Group A had significantly higher erectile function scores on the IIEF-5 at 12 and 18 months than immediately after surgery (P < 0.01), whereas in group B the improvement was not statistically significant. Overall, by 18 months after surgery five of 12 men in group A had achieved spontaneous unassisted erection or erection assisted with sildenafil, while three of 10 in group B achieved an erection assisted with sildenafil (not significant).. These data suggests that laparoscopic sural nerve grafting during radical prostatectomy is feasible and safe; nevertheless we cannot conclude that sural nerve grafting is more effective than preserving the neurovascular bundle alone in retaining sexual potency. More research is required to validate the effectiveness of this technique.

Topics: Aged; Case-Control Studies; Erectile Dysfunction; Feasibility Studies; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Penile Erection; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Sural Nerve

Erectile dysfunction (ED) persists for years following curative therapies for clinically localized prostate cancer. We report use and treatment outcomes in a 5-year interval in a population based cohort from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study.. A sample of 1,977 men with localized prostate cancer who received external beam radiation therapy or radical prostatectomy in 1994 to 1995 were surveyed for 5 outcome measures of ED treatment, namely treatment, perceived helpfulness, erectile sufficiency, sexual activity frequency and erection maintenance. Subjects were surveyed 6, 12, 24 and 60 months after prostate cancer diagnosis.. Overall 50.5% of men ever used ED treatment. The use of ED treatments increased during the study course. Subject age, regular sexual partner and baseline sexual activity were factors positively associated with ED treatments. While it was used uncommonly (1.9%), a penile prosthesis was perceived as the most helpful ED treatment (helped a lot in 52% of respondents). Sildenafil helped a lot in 12% of respondents. Erectile fullness, erection maintenance and sexual activity frequency were modestly improved in men using ED treatment compared with those in men not using ED treatment.. Approximately half of the patients in this population based cohort of men used ED treatment during the 5 years following prostate cancer diagnosis. Men using ED treatments had modest improvement in sexual function compared with men that in who did not receive ED treatment at 60 months. More effective treatments for ED following local therapy for prostate cancer are needed.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Aged; Cohort Studies; Erectile Dysfunction; Humans; Male; Middle Aged; Multicenter Studies as Topic; Penile Implantation; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; SEER Program; Sildenafil Citrate; Sulfones

To (a) locate neurovascular bundles (NVB) on pelvic CT and (b) retrospectively evaluate relationships between radiation dose to structures putatively involved in prostate brachytherapy-induced erectile dysfunction (ED) and incidence of postbrachytherapy ED.. (a) Right/left NVB were identified on nine prostate MRIs. Structures visible on MRI and CT were cross-referenced. Cross-sectional area of each NVB was measured. (b) All patients treated with implant alone and whose treatment was planned on Variseed (Varian Medical Systems, Palo Alto, CA), with follow-up of >12 months were included; n = 41. Median follow-up was 20 months. All patients were potent (+/- sildenafil) before implant (erection sufficient for intercourse). The right/left NVB (using results from part "a"), penile bulb, and right/left crus were outlined on postimplant CT. Volumes and doses to these structures were calculated.. (a) On prostate MRI, NVB was consistently located where the prostate border bends away from the levator ani, at the gland's smallest radius of curvature. Average area of the circle best encompassing the NVB = 0.27 cm(2); diameter was 0.58 cm. (b) 11 of 41 (27%) patients had ED; 30 of 41 were potent (15 with sildenafil). There was no significant difference between potent/impotent patients in isotope, age, diabetes, hypertension, follow-up, or volume of prostate, bulb, right/left NVB, or right/left crus. There was a relationship between smoking and ED (p = 0.05). There was a relationship between bulb %D90 and ED: >10% 67% (4 of 6) vs. <10% 20% (7 of 35) (p = 0.03), which remained when controlling for smoking. There was no relationship between dose to left NVB and potency. There was paradoxical decreased risk of ED with right NVB %V100 >60% (p = 0.019), and right NVB %D60 >100% (p = 0.003). There was no relationship between dose to right/left crus and ED.. A reliable method for localizing NVB on CT is demonstrated. There is no increased risk of prostate brachytherapy-induced ED with increasing dose to crus or NVB at the doses given in this study. There is a possible dose-response relationship between dose to the bulb and risk of ED.

Topics: Brachytherapy; Dose-Response Relationship, Radiation; Erectile Dysfunction; Humans; Magnetic Resonance Imaging; Male; Nerve Endings; Pelvis; Penis; Piperazines; Prostate; Prostatic Neoplasms; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Tomography, X-Ray Computed; Vasodilator Agents

Topics: Aged; Biopsy; Erectile Dysfunction; Hormone Replacement Therapy; Humans; Hypogonadism; Male; Phosphodiesterase Inhibitors; Piperazines; Prostate; Prostatic Neoplasms; Purines; Risk; Sildenafil Citrate; Sulfones; Testosterone

Our institution previously described a surgical technique for preservation of accessory pudendal arteries at radical retropubic prostatectomy. Since then, we have expanded our experience. We now report our refinements in the surgical technique, illustrated with video, and the influence of accessory artery preservation on the recovery of sexual function after radical retropubic prostatectomy (RRP).. Between 1987 and 2003, 2399 potent men underwent RRP. Of the 2399 men, 84 (4%) were identified with accessory pudendal arteries. Of the 84 men, 52, who underwent bilateral nerve-sparing surgery, were available for evaluation. We identified a control population, without accessory pudendal arteries, who were matched for age, stage, and neurovascular bundle status. Potency was defined as the ability to achieve unassisted intercourse with or without the use of sildenafil. In a Cox proportional hazards model, the effect of artery preservation increased the likelihood of potency more than twofold (relative risk 2.65; 95% confidence interval 1.11 to 6.32; P = 0.028). Kaplan-Meier analysis showed a significantly shorter median time to regain potency among those with artery preservation, 6 versus 12 months (P = 0.020).. Preservation of accessory pudendal arteries may favorably influence the recovery of sexual function and interval to recovery after RRP.

Topics: Adenocarcinoma; Arteries; Cohort Studies; Erectile Dysfunction; Humans; Life Tables; Male; Middle Aged; Penis; Piperazines; Postoperative Complications; Proportional Hazards Models; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome

We examine the impact of nerve sparing technique on the sexual function after radical retropubic prostatectomy for localized prostate cancer.. Between March, 1996 and September 2000, 44 men with clinically localized adenocarcinoma of the prostate who underwent radical retropubic prostatectomy (RRP) were included in this study. The mean age of these patients was 68.7 +/- 4.5 years old (range: 57-75). Among them, 8 patients were impotent preoperatively, 18 patients did not undergo nerve sparing surgery due to technical difficulties, and the remaining 18 potent patients underwent nerve sparing RRP. The postoperative sexual function was assessed by the International Index of Erectile Function (IIEF-6) and patient-reported percentage of recovery of sexual function.. Mean length of follow-up was 14.4 +/- 2.7 months (range 12-18). The IIEF scores and % recovery of sexual function were significantly higher in nerve sparing surgery when compared to that of non-nerve sparing surgery (15.2 +/- 9.0 vs. 2.0 +/- 3.8 and 55 +/- 30% vs. 3 +/- 10%, respectively, p < 0.001). Of the 18 potent patients who underwent nerve sparing surgery, spontaneous erection and successful sexual activity was reported in 4 (22.2%) patients. Eight (44.4%) patients could achieve intercourse either with the aid of sildenafil or intracavernous alprostadil injection. Four (22.2%) patients had partial erection but refused further treatment. Two (11.1%) patients were completely impotent after nerve sparing surgery. Postoperative PSA was 0.10 +/- 0.18 (range 0.01-0.59).. After a mean length of 14.4 months' follow-up, a majority of our patients could achieve sexual activity, and the cancer control following nerve sparing surgery was good. Our results suggest that nerve sparing retropubic radical prostatectomy is indicated in selected patients with localized adenocarcinoma of the prostate.

Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Sexual Behavior; Sildenafil Citrate; Sulfones

Topics: Clinical Trials as Topic; Cross-Over Studies; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Placebos; Postoperative Care; Prostatectomy; Prostatic Neoplasms; Purines; Radiotherapy; Radiotherapy Dosage; Risk Factors; Sildenafil Citrate; Sulfones; Time Factors; Vasodilator Agents

We characterized the effects of sildenafil citrate on the growth and metastasis of human prostate cancer cells in nude mice.. The androgen independent human prostate cancer cell line PC-3 was inoculated into the prostate of nude mice to produce orthotopic primary prostate cancers and metastases. Sildenafil citrate gavage was started on day 31 after tumor cell inoculation and given every other day 15 times (30 days). The 7 mice in the low dose group received 25 mg/kg body weight sildenafil citrate per gavage, while the 7 in the high dose group received 50 mg/kg body weight sildenafil citrate and the 9 in the control group received water. Autopsy was performed on day 75 to evaluate primary tumor growth and metastasis. Plasma cyclic guanosine monophosphate concentrations were measured after the single dose of 50 mg/kg sildenafil citrate in the mice.. Plasma cyclic guanosine monophosphate concentration increased 4-fold 1 hour after sildenafil citrate administration. The plasma concentration decreased rapidly and returned to normal after 8 hours. There was no significant difference in tumor weight between any of the 3 groups. The number of metastatic lymph nodes correlated significantly with primary tumor weight (p = 0.03) with a correlation coefficient of 0.454 but there was no significant correlation between the number of involved lymph nodes and sildenafil administration. Distant metastases were not significantly promoted by sildenafil administration.. Incontinuous oral administration of sildenafil citrate did not promote primary tumor growth and metastasis in an orthotopic prostate cancer model.

Topics: Animals; Cyclic GMP; Disease Models, Animal; Lymphatic Metastasis; Male; Mice; Mice, Inbred BALB C; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Tumor Cells, Cultured; Vasodilator Agents

We emphasize the good results obtained by authors of the United States of North America and Europe using prostate brachytherapy in the treatment of localized prostate cancer.. We report 50 patients with stage T1c-T2c treated during the last twenty one months (September 2000, June 2001). Two groups were made--according to Gleason, PSA, local infiltration and percentage of tumor volume in the Biopsy--in low and high risk patients. We report the methodology used in the surgical procedure.. We found the nadir of PSA was 0.5-1 in seven patients followed during eighteen months, and fifteen patients followed during twelve months. We had a failure in two patients. A reference is made about two patients with previously TURP and one with open prostatectomy, with very good post-operative results. Secondary effects are essentially irritative symptoms, well controlled by medical treatment. Four patients had acute urinary retention, one of them persistent. Normal erections were found in thirty five patients, and partial in fifteen, which had a very good respond to Sildenafil. Four cases had partial incontinence, currently only one persist during sleep.. We have had very good results during the first twenty one months of treatment of cancer of the prostate with brachytherapy. In our opinion the procedure is a very valid option of treatment for this disease.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antigens, Neoplasm; Biomarkers, Tumor; Brachytherapy; Combined Modality Therapy; Disease-Free Survival; Erectile Dysfunction; Hematuria; Humans; Iodine Radioisotopes; Male; Middle Aged; Piperazines; Prospective Studies; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Purines; Radiopharmaceuticals; Remission Induction; Sildenafil Citrate; Sulfones; Transurethral Resection of Prostate; Treatment Outcome; Urinary Incontinence; Urination Disorders; Vasodilator Agents

To retrospectively evaluate the relationship between the radiation dose to the bulb of the penis and the development of erectile dysfunction (ED) in patients undergoing permanent prostate brachytherapy without external beam radiation therapy.. Twenty-three men who developed ED after transperineal ultrasound-guided permanent prostate brachytherapy for clinical T1/T2 adenocarcinoma of the prostate gland were paired with 23 similar men who maintained potency after implantation. Potency was defined as an erection sufficient for vaginal penetration. The mean and median follow-up for the entire group was 34.6 +/- 13.7 months and 32.8 months, respectively. Patients were implanted with either (125)I (145 Gy TG-43) or (103)Pd (115 Gy, pre-NIST-99). No patient received external beam radiation therapy either before or after brachytherapy. The bulb of the penis was outlined at 0.5-cm intervals on the Day 0 postimplant CT scan. The radiation dose distribution to the bulb of the penis was defined in terms of the minimal dose delivered to 25%, 50%, 70%, 75%, 90%, and 95% of the bulb (D(25), D(50), D(70), D(75), D(90), and D(95)).. The radiation dose delivered to the bulb of the penis in men with postbrachytherapy-induced ED was statistically greater for all evaluated dosimetric parameters (D(25), D(50), D(70), D(75), D(90), and D(95)). Multivariate analysis indicated that dose to the bulb of the penis and patient age at the time of implant were predictive of postimplant ED, whereas choice of isotope had no effect. Among potent patients, 19/23 had D(50) < or = 40% of prescribed minimal peripheral dose, whereas for the impotent patients, 19/23 had D(50) >40% of the minimal peripheral dose. Of the impotent patients, 17 utilized sildenafil, with 15 experiencing a favorable response (88%).. Our data suggest that prostate brachytherapy-induced impotence is highly correlated with the radiation dose delivered to the bulb of the penis. With Day 0 dosimetric evaluation, the radiation dose delivered to 50% of the bulb of the penis should be maintained at 50 Gy or less to maximize post-treatment potency. Fortunately, the majority of the brachytherapy-induced ED population responds favorably to sildenafil.

Topics: Adenocarcinoma; Aged; Brachytherapy; Erectile Dysfunction; Humans; Iodine Radioisotopes; Male; Middle Aged; Palladium; Penis; Phosphodiesterase Inhibitors; Piperazines; Prostatic Neoplasms; Purines; Radiation Dosage; Radioisotopes; Retrospective Studies; Sildenafil Citrate; Sulfones

To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer.. The study included 85 patients (mean age 59.5 years, range 50--75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildenafil; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year.. Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection sufficient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildenafil and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow-up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildenafil, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device.. Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow-up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.

Topics: Aged; Erectile Dysfunction; Humans; Injections; Male; Middle Aged; Papaverine; Phosphodiesterase Inhibitors; Piperazines; Postoperative Care; Prostatectomy; Prostatic Neoplasms; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Treatment Failure; Urination Disorders; Vacuum; Vasodilator Agents

The evaluation of potency preservation after treatment of localized prostate cancer with transperineal permanent prostate brachytherapy (PPB) and the efficacy of sildenafil were studied.. This study comprised 482 patients who were able to maintain an erection suitable for intercourse before treatment from a cohort of 1166 patients with clinically localized prostate cancer treated with PPB. All patients have been followed prospectively, and actuarial analysis was performed to assess potency preservation over time. Patients treated with sildenafil were evaluated as to its efficacy.. The median follow-up of this cohort was 34 months (6--92), with a median age of 68 years (47--80). Potency was preserved in 311 of the 482 patients, with a 5-year actuarial potency rate of 52.7%. The 5-year actuarial potency rate for patients treated with PPB as monotherapy was 76%, and, for those treated with combination external beam radiotherapy (EBT) + PPB, 56% (p = 0.08). Patients treated with neoadjuvant androgen deprivation (NAAD) + PPB had a 5-year potency rate of 52%, whereas those with combination EBT + PPB + NAAD had a potency rate of 29% (p = 0.13). Cox regression analysis identified that pretreatment use of NAAD and patient age predicted for impotence (p = 0.0001 and 0.04, respectively). Of 84 patients treated with sildenafil, 52 had a successful outcome (62%). The response to sildenafil was significantly better in those patients not treated with NAAD (p = 0.04).. The actuarial potency rates at 5 years for patients treated with PPB are lower than generally acknowledged, except for those patients treated with PPB as monotherapy. Patients who received sildenafil exhibited improved potency in a majority of cases.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Brachytherapy; Cohort Studies; Combined Modality Therapy; Confounding Factors, Epidemiologic; Erectile Dysfunction; Follow-Up Studies; Humans; Life Tables; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; New York; Piperazines; Proportional Hazards Models; Prospective Studies; Prostatic Neoplasms; Purines; Quality of Life; Radiation Injuries; Radiotherapy, High-Energy; Sildenafil Citrate; Sulfones; Vasculitis

We sought to assess potency preservation after three-dimensional conformal radiotherapy (3D-CRT) in prostate cancer patients eligible for radical prostatectomy, conventional radiotherapy, 3D-CRT, or transperineal prostate implantation. Patients with more advanced disease are commonly treated with hormonal therapy, which can cause impotence, and were consequently excluded from the analysis. Between December 1991 and June 1998, 198 prostate cancer patients were treated with 3D-CRT at the University of California, Davis Medical Center. Fifty-two of these patients had a pretreatment prostate-specific antigen (PSA) level of 10.0 ng/ml or less, a Gleason score of 6 or less, and a 1997 AJCC clinical stage T1bN0M0 to T2bN0M0. One patient was not evaluable. None of the 51 evaluable patients had diabetes mellitus. In 40 patients, the prostate gland only was irradiated to a total dose of 66 to 79.2 Gy by using daily 1.8-Gy fractions. In 11 patients, the prostate and seminal vesicles were treated to 44 to 55.8 Gy. Lymph nodes were not included in the clinical target volume. The median age was 68 years, and the median length of follow-up was 15 months. Potency in this study is defined as an erection sufficient for vaginal penetration. Kaplan-Meier analysis was used to describe potency as a function of time after 3D-CRT. Of the 51 evaluable patients, 35 (69%) were potent, 15 were impotent, and 1 was sexually inactive before 3D-CRT. Kaplan-Meier estimates of the potency preservation rates 1, 2, and 3 years after 3D-CRT are 100%, 83%, and 63%, respectively. On multivariate analysis, age, total radiation dose, and a history of transurethral resection of the prostate did not significantly affect potency preservation rates. Three (43%) of 7 patients who became impotent after 3D-CRT and used sildenafil were subsequently able to achieve erections sufficient for vaginal penetration. The preliminary results reported herein suggest that approximately two thirds of prostate cancer patients will retain their potency 3 years after 3D-CRT. Further follow-up is necessary to assess long-term potency after 3D-CRT. Sildenafil should be considered in patients who develop radiation-induced impotence.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Age Factors; Aged; Analysis of Variance; Brachytherapy; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Multivariate Analysis; Neoplasm Staging; Penile Erection; Penis; Phosphodiesterase Inhibitors; Piperazines; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Purines; Radiotherapy Dosage; Radiotherapy, Conformal; Seminal Vesicles; Sildenafil Citrate; Sulfones; Transurethral Resection of Prostate

The etiology of erectile dysfunction after definitive local therapy for carcinoma of the prostate gland represents a multifactorial phenomenon including neurogenic compromise, venous insufficiency, local trauma, and psychogenic causes. It has been suggested that impotence after prostate brachytherapy is a consequence of excessive radiation dose to the neurovascular bundles (NVB). Herein we evaluate the potential relationship between radiation dose to the NVB and the development of erectile dysfunction following prostate brachytherapy.. The radiation dose to the NVB was evaluated for 33 patients who developed erectile dysfunction (ED) following brachytherapy plus 21 additional patients who were potent before and subsequent to brachytherapy. Of the 54 patient study group, the median follow up was 37 months, and 25 patients were managed with (125)I as a monotherapeutic approach and 29 received (103)Pd as a boost following 45 Gy of external beam radiation therapy. Radiographic localization of the NVB was performed via a two-dimensional geometric model that placed 3-NVB calculation points on the left and right posterolateral side of each 5-mm CT slice. Parameters evaluated included dose-surface histograms, dose parameters via point doses on each slice, the magnitude of the dose in relationship to the distance from the base, and the relationship between NVB radiation dose in patients with and without ED, patient response to sildenafil and case sequence number.. In terms of percent prescribed minimum peripheral dose (% mPD), there was no significant difference in mean neurovascular bundle dose between potent and impotent patients, between the isotopes ((125)I or (103)Pd), mono- or boost therapy, or side of the prostate for which the overall average was 217% +/- 55% of mPD. There was also no significant dosimetric difference in terms of response to sildenafil based on a multivariate analysis which included % mPD and various dose thresholds and side of the gland. The dose distribution over the length of the prostate rose smoothly from the base and apex to peak at midgland in (125)I implants while (103)Pd implants had a relatively constant dose over the length of the prostate. Considering the calculation grid as forming a 6-mm wide ribbon along each side of the prostate, the average patient had 70 mm(2) area receiving at least 300% of mPD.. In this study, no relationship between radiation dose to the NVB and the development of post brachytherapy erectile dysfunction was discernible. Such a difference may become evident with additional follow-up. If long-term brachytherapy-induced erectile dysfunction is related to the radiation dose to the NVB, the ultimate preservation of potency following prostate brachytherapy may be markedly inferior to what has been reported. Nevertheless, the majority of this patient population responded favorably to sildenafil.

Topics: Age Factors; Brachytherapy; Erectile Dysfunction; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Neurons; Palladium; Phosphodiesterase Inhibitors; Piperazines; Prostate; Prostatic Neoplasms; Purines; Radioisotopes; Radiotherapy Dosage; Regression Analysis; Sildenafil Citrate; Sulfones

Topics: Age Factors; Enzyme Inhibitors; Erectile Dysfunction; Humans; Male; Meta-Analysis as Topic; Penile Erection; Piperazines; Prostatectomy; Prostatic Neoplasms; Purines; Radiotherapy; Sildenafil Citrate; Sulfones

Topics: Circumcision, Male; Enzyme Inhibitors; Erectile Dysfunction; Finasteride; Humans; Male; Mass Screening; Pain; Piperazines; Plant Extracts; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Serenoa; Sildenafil Citrate; Sulfones; Urology

Topics: Erectile Dysfunction; Humans; Male; Patient Education as Topic; Piperazines; Prostatic Neoplasms; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Urinary Incontinence