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