| Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function. | |
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MedLine Citation:
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PMID: 20477827 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: BJU international Volume: 106 ISSN: 1464-410X ISO Abbreviation: BJU Int. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-27 Completed Date: 2011-01-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100886721 Medline TA: BJU Int Country: England |
Other Details:
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Languages: eng Pagination: 1524-7 Citation Subset: IM |
Copyright Information:
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© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL. |
Affiliation:
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Glickman Urological and Kidney Institute, Department of Regional Urology, Cleveland Clinic, Cleveland, OH, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brachytherapy / adverse effects* Epidemiologic Methods Erectile Dysfunction / etiology, prevention & control* Humans Male Middle Aged Phosphodiesterase Inhibitors / therapeutic use* Piperazines / therapeutic use* Prostatic Neoplasms / radiotherapy* Purines / therapeutic use Sulfones / therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Phosphodiesterase Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 139755-83-2/sildenafil |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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