Document Detail

Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function.
MedLine Citation:
PMID:  20477827     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: 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.
PATIENTS AND METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.
Geetu Pahlajani; Rupesh Raina; J Stephen Jones; Michael Burdick; Marwan Ali; Jianbo Li; Arul Mahadevan; Jay Ciezki; Craig Zippe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJU international     Volume:  106     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-27     Completed Date:  2011-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1524-7     Citation Subset:  IM    
Copyright Information:
Glickman Urological and Kidney Institute, Department of Regional Urology, Cleveland Clinic, Cleveland, OH, USA.
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MeSH Terms
Brachytherapy / adverse effects*
Epidemiologic Methods
Erectile Dysfunction / etiology,  prevention & control*
Middle Aged
Phosphodiesterase Inhibitors / therapeutic use*
Piperazines / therapeutic use*
Prostatic Neoplasms / radiotherapy*
Purines / therapeutic use
Sulfones / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Phosphodiesterase Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 139755-83-2/sildenafil

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