PURPOSE: Adjuvant daily sildenafil citrate (SC) during and after radiotherapy for prostate cancer for erectile function preservation was studied.
METHODS: A randomized, prospective trial of 279 patients with localized prostate cancer treated with radiotherapy compared daily SC (50 mg) to placebo (2:1 randomization). Medication/placebo was initiated 3 days pretreatment and continued daily for 6 months. Patients completed the International Index of Erectile Function (IIEF) including the erectile function domain (EF) and International Prostate Symptom Score questionnaires pretherapy and at 3, 6, 9, 12, 18, and 24 months post-radiotherapy. All IIEF domains were scored.
RESULTS: At 12 months, EF scores were better for SC (P=0.018) than placebo, 73% of SC vs 50% of placebo patients had mild/no erectile dysfunction (ED) (P=0.024), and the SC arm had superior overall satisfaction (P=0.028) and IIEF total scores (P=0.044). At 24 months, EF scores were no longer significantly better for SC (P=0.172), yet overall satisfaction scores were higher (P=0.032) and IIEF scores marginally significantly higher (P=0.097). SC sexual desire scores were higher (P=0.049) at 24 months despite completing drug therapy 18 months prior. At 24 months, 81.6% of SC and 56.0% of placebo patients (P=0.045) had functional erections (with or without ED medication).
CONCLUSIONS: Daily SC during and after radiotherapy for prostate cancer was associated with improved overall sexual function compared with placebo for various sexual function domains. This is the first randomized, prospective, controlled trial to demonstrate utility of a PDE5 inhibitor as a rehabilitation strategy in prostate cancer radiation therapy patients.
Written by:
Zelefsky MJ, Shasha D, Branco RD, Kollmeier M, Baser RE, Pei X, Ennis R, Stock R, Bar-Chama N, Mulhall JP. Are you the author?
Department of Radiation Oncology and Urology, Memorial Sloan-Kettering Cancer Center; Department of Radiation Oncology, Continuum Cancer Center of New York; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiation Oncology and Urology, Mt Sinai Medical Center, Memorial Sloan-Kettering Cancer Center, New York, New York.
Reference: J Urol. 2014 Mar 3. pii: S0022-5347(14)00355-3.
doi: 10.1016/j.juro.2014.02.097
PubMed Abstract
PMID: 24603102
UroToday.com Prostate Cancer Section
