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Regaining Erections After Prostate Cancer Treatments - Try All Methods

New York /PSA Rising/ July 16, 2001 -- With the earlier detection of prostate cancer and the increasing demand for treatment while the disease is organ-confined, more men are asking about quality of life issues. A man's prostate, which helps make fluid for ejaculation of his sperm, lodges close by nerves, muscles and blood vessels in his penis. After any radical therapy aimed to eliminate cancer in the prostate, loss of erectile potency is a particular concern.

Development of erectile dysfunction (ED) may occur, says Dr. J. Vale at Sat Mary's Hospital, London UK, in as many as "perhaps a third of patients treated by radiotherapy and 30-70% of patients treated by radical prostatectomy."

"Although it is assumed that the ED relates to damage to the nerves subserving erection," Vale says, "this view has been questioned recently and in at least a proportion of patients the cause appears to be vascular."

At this UK hospital, Viagra (sildenafil) was tried as first-line therapy for erectile problems "assuming there are no contraindications, such as severe ischaemic heart disease or nitrate therapy." The results were more positive after radiotherapy -- "improvement in 70% of patients"; less so after radical prostate surgery -- "a response rate of 40-50%."

At two centers in Israel, a majority of men who had erectile dysfunction (impotence) after radical surgery for prostate cancer got more help from self-injection than from Viagra. The study is interesting because it took account of patient preference and "usability" of method at home, not just how well a method worked in a doctor's office.

The study enrolled 85 patients aged 50 to 75 (mean age 59.5 years). Allt he men had erectile dysfunction after RRP. Urologists at Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv offered the men four methods one after another.

If the first method failed or the patient was not happy with it in the doctor's office or at home, he passed to the next method.

To start out, all the patients tried a pump-style vacuum erection device. For those who were not happy with results, the next step was Viagra (sildenafil). If Viagra didn't do the trick, the men went on to try "intracorporal injection," using a miniature hypodermic needle to inject an erectile drug into the penis. Beyond that they could go to combination of vacuum erection device plus self-injection.

The 85 patients were followed for a year. Almost all of the men (92%) responded to the vacuum erection device (with an erection sufficient for vaginal penetration), but most of them disliked it. Only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 tried Viagra/ sildenafil (they had no health problems that might make it risky for them) and 14 of them (20%) had a positive response.

From other studies it appears that for some men Viagra only begins to work after several tries. In this Israeli study, the 60 patients (out of 85) who got no results or did not like the vacuum pump and out of 74 who got nothing from Viagra then tried self-injection.

Of these 60 men, 51 (85%) had a positive response. And 4 of the 9 for whom nothing so far had worked well responded to injection plus vacuum therapy. Only five out of 85 patients were left with no improvement from any of the four methods.

After a year of follow-up, 76 of the 80 patients were successfully continuing treatment at home. Out of eleven who started on the vacuum pump, seven of them (9% of the whole group) were still using. Where 14 responded to Viagra/sildenafil upfront, 11 (14%) continued to take it. Number of men who used injections went up over the year from 51 to 54 (71% of the whole group); and four (5%) continued to rely on injection plus the vacuum erection device.

"Overall," the authors state, "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."

Another recent study showed that Bayer's updated Viagra-style drug, vardenafil, "significantly improved ... ability to consistently complete sexual intercourse." These men had not all undergone prostate surgery, though -- they had diverse situations and health problems. In any case, using vardenafil, improvement was achieved early and maintained over the three-month study period, according to data presented at the Annual Meeting of the American Urological Association (AUA).

Given the worldwide reach of Viagra advertising campaigns and the convenience of a pill, it seems surprising how many of these Israeli men got better results from the injections.

In any case, options for men who lose their erections after radical prostate surgery are much improved today. As this Israeli study shows, persistence is worthwhile and it's OK to reject a method that doesn't feel right and try another. If one or two methods don't work, chances are still high that another method will.

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Sources & Links:

Erectile dysfunction following radical therapy for prostate cancer. Vale J. St. Mary's Hospital, W2 1NY, London, UK. Radiother Oncol 2000 Dec;57(3):301-5

Comparative evaluation of treatments for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy. Daniel J, Israilov S, Segenreich E, Livne PM. Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. BJU Int 2001 Jul;88(1):58-62

Related Studies:

Health-Related Quality-of-Life Effects of Radical Prostatectomy and Primary Radiotherapy for Screen-Detected or Clinically Diagnosed Localized Prostate Cancer By Joanna B. Madalinska, et al, Departments of Public Health, Erasmus University, and Department of Urology, Erasmus University Rotterdam and Academic Hospital Rotterdam, the Netherlands. Journal of Clinical Oncology, Vol 19, Issue 6 (March), 2001: 1619-1628

Health-related quality of life in patients with screen-detected versus clinically diagnosed prostate cancer preceding primary treatment. Madalinska JB, et al. Prostate. 2001 Feb 1;46(2):87-97.

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