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Prostate Cancer SymposiumAn Educational Initiative For Patients, Spouses, Advocates and Healthcare Professionals
Restoring Quality of Life:Managing Side-effects/Pain Control
David Shin, MDBiren Saraiya, MD
Supported by educational grants from:
IN CONJUNCTION WITH
Men’s Health:Men’s Health:Optimizing Erectile Function after Prostate Optimizing Erectile Function after Prostate
Cancer TreatmentCancer Treatment
David Shin, M.D.Chief, Center for Sexual Health & Fertility
Department of UrologyHackensack University Medical Center
Erectile Dysfunction after Prostate Cancer Treatment
• Surgery (27-43%)– Open– Laparoscopic– Robotic
• Radiotherapy (38-62%)– Conventional– 3-D Conformal Radiotherapy (CRT)– Intensity Modulated Radiotherapy (IMRT)
• Brachytherapy (30-53%)– Iodine-125 (I-125)– Palladium-103 (Pd-103)
Penile Rehabilitation
• Goal:– Incorporate preventative measures to preserve
erectile function after prostate cancer treatment
• Concept:– Improve Cavernosal Oxygenation– Promote Endothelial Protection– Prevent cavernosal nerve injury-induced
structure changes
• Expectations
Penile Rehabilitation: Treatment Options
• Phosphodiesterase (PDE) V Inhibitors
• Vacuum-assisted Erection Device (VED)
• Intraurethral Suppository
• Intracorporeal Injections
• Surgery: Penile Prosthesis
Penile Rehabilitation: Treatment Options
• Phosphodiesterase (PDE) V Inhibitors
• Vacuum-assisted Erection Device (VED)
• Intraurethral Suppository
• Intracorporeal Injections
• Surgery: Penile Prosthesis
Treatment Options for ED
Talk therapy/sexual
counselling
Oral therapy
Injection therapy
Intraurethral therapy
Vacuum device/rings
Penile implants
Treatment for ED: PDE 5 Inhibitors
NH
N
N
O
O
C H3
O
O
H
H
Tadalafil
NH
N
N
N
CH3
CH3O
O
CH3
SN
NH C3
O O
Sildenafil
NH
NN
N
CH3
O
O
CH3
SN
N
O O
CH3
Vardenafil
H C3
(Viagra®)
(Levitra®)
(Cialis®)
Vacuum Erection Device
Treatment of ED
Intraurethral suppositoryTreatment of ED
Intracavernosal Injection Therapy
CaverjectCaverject®
(Alprostadil)(Alprostadil)
TrimixTrimix®
(PGE, (PGE, Phentolamine, Phentolamine, Papaverine)Papaverine)
Treatment of ED
Inflatable Penile ProsthesisTreatment of ED
Penile Rehabilitation Success Rates after Radical Prostatectomy
• PDE V Inhibitors (86%):– Bannowsky et al. BJU Int 2008 101: 1279-83– McCullough et al. J Sex Med 2008 5: 476-83
• VED (17%):– Kohler et al. BJU Int 2007 100: 858-62– Raina et al. Int J Impot Res 2006 18: 77-81
• Intraurethral Suppository (74%):– Raina et al. BJU Int 2007 100: 1317-21
• Intracorporeal Injection Therapy (52%):– Mulhall et al. J Sex Med 2005 2(4): 532-40
Penile Rehabilitation:HUMC Protocol
• 2 WEEKS PRIOR TO SURGERY:– Sildenafil 25 mg every night
• AFTER SURGERY:– Resume sildenafil 25 mg every night after catheter removal
• 1 MONTH AFTER SURGERY:– Sildenafil 25 mg every night + sildenafil 100 mg
prior to intercourse– Start Vacuum-assisted erection device 5-10 min/day
• 3 MONTHS AFTER SURGERY:– Incorporeal injection therapy or intraurethral suppository therapy if
above regimen is ineffective