PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? Opinion: No

The advancement and refinement in prostate cancer detection and treatment modalities have contributed to a younger patient population undergoing radical prostatectomy (RP) (1). Although it is effective in treating prostate cancer, radical prostatectomy has also been shown to compromise erectile function (EF), and therefore the patient’s quality of life and general well being (2). Alemozaffar et al. (3) attempted to predict erectile function after prostate cancer patients undergoing RP, external radiotherapy and brachytherapy. Pretreatment sexual health related quality of life score, age, serum prostate-specific antigen level, race/ethnicity, body mass index and intended treatment details were associated with functional erections 2 years after treatment. They found that 48% of patients (n=1027) with functional erections prior to treatment reported erectile dysfunction 2 years after treatment. In the prostatectomy cohort, 60% of patients with prior functional erections reported erectile dysfunction, along with 42% and 37% of the external radiotherapy and brachytherapy cohorts, respectively. The Prostate Cancer Outcomes study revealed 60% of men experienced self-reported erectile dysfunction 18 months after radical prostatectomy, and only 28% of men reported erections firm enough for intercourse at a 5-year follow-up (4). Many urologists believe more patients would be willing to undergo surgical treatment if it were not for the possibility of developing postoperative ED (2). The discovery of the neurovascular bundle sparing technique by Dr. Patrick Walsh enabled urologists to provide hope of regaining erectile function after radical prostatectomy (5). However, despite meticulous dissection to preserve the neurovascular bundle, there is evidence that neuropraxia, ischemic and hypoxic nerve insults, fibrotic remodeling, and apoptosis of cavernous smooth muscle contribute to post-surgery erectile dysfunction (6). DIffERENCE Of OPINION