Phosphodiesterase Type 5 Inhibitors In Management Of Erectile Dysfunction Secondary To Treatments For Prostate Cancer

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Prostate / Prostate Cancer;  Urology / Nephrology
Article Date: 12 Jun 2008 - 11:00 PDT

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UroToday.com - A group from the UK led by Bridget Candy report a meta-analysis in the BJU International on phosphodiesterase type 5 inhibitors (PDE5i) for the treatment of erectile dysfunction (ED) secondary to treatments for prostate cancer (CaP).

Only randomized controlled trials were included and outcomes using validated scales such as the IIEF and SEP, successful sexual intercourse, time to effect, treatment satisfaction and health-related QOL were extracted. Of 10,340 citations, only 5 met full inclusion criteria for this review. In total, 959 men participants were included, 2 trials were multi-centered, 2 were cross-over designs, and all were pharmaceutical company funded. Two trials evaluated the effects of sildenafil, 2 tadalafil and one vardenafil. Most were at the highest recommended doses of these drugs. The authors rate the design of the 5 trials as fair. Attrition bias in the studies was 13-25%.

In all trials the PDE5i drugs were significantly favored over placebo. In 2 trials the combined odds ratio for improvement in erections was 10.09. In one trial the OR from successful intercourse was 2.88. All trials had reported side effects, most commonly dyspepsia, flushing, headache, nausea and rhinitis. In combined data from 2 trials totaling 513 patients, significantly fewer patients receiving the PDE5i withdrew secondary to inefficacy. In one trial, the effectiveness of the PD5i by dosage and unilateral vs. bilateral nerve sparing radical prostatectomy found no difference.

BJU Int. 2008 Apr 10 (Epub ahead of print)
doi: 10.1111/j.1464-410X.2008.07668.x

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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