DOI: 10.1097/01.COT.0000290309.68442.32
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Issn Print: 0276-2234
Publication Date: 2003/04/10
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Excerpt
Treatments for men with localized prostate cancer frequently result in organic erectile dysfunction, necessitating medical treatment to restore sexual satisfaction. Treatment options include the use of oral medications (mainly sildenafil), penile injections, vacuum devices, and penile prostheses. This survey concludes that the success of medical treatments is limited, especially in men receiving neoadjuvant antiandrogen therapy.
The survey was sent to 2,636 men who were treated initially with either radiotherapy or prostatectomy for localized prostate cancer. The response rate was 49% (1,236 men), and the average age of the respondents was 68.6 years (range of 42 to 88).
A total of 85% of the men (676) reported having erectile dysfunction within the last six months, with 36% of participants having the problem prior to receiving treatment for prostate cancer. Of those who had a sexual problem, 59% reported trying at least one medical or psychological treatment for erectile dysfunction.
Oral sildenafil was by far the most popular treatment, with 549 men (52%) reporting the use of it. Vacuum device was the second most popular, used by 197 men (19%), closely followed by penile injections by 179 men (18%). Only 2% of men (16) in this sample opted for penile prosthesis.
Overall, 49% of the men who tried sildenafil (the least invasive therapeutic option) reported at least some improvement in sexual function, and 39% of men were still using it at the time of the survey.
However, according to a validated measure of erectile function, only half of this group of continuing users achieved erections that were near-normal in firmness and reliability.
Of the men using a vacuum device, 44% reported having somewhat improved sexual function, 19% had greatly improved sexual function, and 41% were still using the treatment.
Penile injections were associated with somewhat improved sexual function in 43% of respondents, greatly improved sexual function in 29%, and 34% of the men were still using the treatment.
Only the most invasive treatments—specifically penile injections and penile prosthesis surgery—achieved success rates that greatly improved sex for more than 25% of the men who tried them. Patient satisfaction was highest for the inflatable penile prosthesis, with approximately 75% of men reporting that they are sexually active and satisfied, and 81% continuing to use it.
All current treatments, except for penile prosthesis, had dropout rates that exceeded 50%. At an average of four and a half years of follow-up, only 30% of men were using a therapy to improve erectile function.
The success of treatment was more likely achieved in men who tried two or more options. Other factors associated with a positive outcome were younger age, potency before prostate treatment, and putting a higher priority on preserving sexual function when choosing a treatment for prostate carcinoma.
Additionally, men in relationships were more likely to try a treatment for erectile dysfunction, particularly if the sexual partner had good sexual function. The survey also confirmed that men in newer relationships, especially those with a significantly younger partner, were more likely to be motivated to try such treatment.
The authors recommend that sexual counseling for men treated for prostate cancer routinely include their partners; although most men perceive erectile dysfunction as an individual problem, sex takes place within the context of a relationship. Many couples are not adequately prepared to incorporate a medical treatment for erectile dysfunction into their sex lives, and partners may have sexual problems themselves.
“Ethical Communication in Clinical Trials: Issues Faced by Data Managers in Obtaining Informed Consent” by Winnie Y. Loh, BPharm, Phyllis N.
