Recovery of sexual function after prostate cancer treatment.
OBJECTIVE
The estimated disease-free survival rates are approximately equivalent across standard treatments for localized prostate cancer. We aim to review the efforts being made to reduce posttreatment erectile dysfunction, a major morbidity of these therapies.


RESULTS
Potency as an important factor in a patient's decision about choosing a form of therapy has been demonstrated in the literature. For nerve-sparing surgery, though some proponents of laparoscopic radical prostatectomy believe it may confer an advantage over the open surgical techniques, the published data is scarce and has yet to demonstrate a true difference. Enthusiasm has declined for sural nerve grafting because of the associated complexity of the procedure and inconsistent results. Concurrent implantation of a penile prosthesis is an option for certain patients who already have some baseline erectile dysfunction or are not candidates for nerve-sparing surgery. Agents such as phosphodiesterase inhibitors, immunophilin ligands, and recombinant human erythropoietin have demonstrated potential benefits in early reports of both in-vitro and ongoing clinical trials.


CONCLUSIONS
Currently, no standard treatment or prophylaxis exists for posttreatment erectile dysfunction. Neuro-protective and regenerative therapies, including the immunophilin ligands, hold promise to reduce the morbidity of localized prostate cancer therapy.
Donatucci
Craig F
CF
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. donat001@mc.duke.edu
Greenfield
Jason M
JM
D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D013497:Sural Nerve / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods