title: Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function.
abstract: OBJECTIVE
  To examine the early use of phosphodiesterase-5 inhibitor (PDE-5i; sildenafil citrate) in preventing subsequent erectile dysfunction (ED) after (monotherapy) prostate brachytherapy (PB, an accepted option for Gleason 6 or low-volume Gleason 7 prostate cancer), as PB is currently being offered more frequently in younger patients, and ED can be a side-effect often within the first 12 months after treatment.
  
  
  METHODS
  We examined a single-surgeon series of 69 patients who had been treated with PB from 2002 to 2005. All patients had a follow-up of ≥ 1 year; prospectively, and patients had baseline, 6- and 12-month assessments using the Sexual Health Inventory for Men (SHIM) and International Index of Erectile Function (IIEF)-6 scores. The 69 patients were divided into early treatment with PDE-5i (31) and not treated with PDE-5i (38), and their SHIM and IIEF-6 scores were compared at baseline, 6 and 12 months. Daily sildenafil (25-50 mg) was given immediately after PB for 12 months. Overall, for the entire group, the mean prostate-specific antigen (PSA) level was 6.8 ng/mL; 78% had Gleason 6 cancer and 20% had Gleason 7 (3 + 4) cancer. The mean age in the early PDE-5i group was 64.8 years, and was 66.0 years in the no-PDE-5i group. The mean radiation dose in the early PDE-5i group was 50.2 Gy, and 43.9 Gy in the other group (P= 0.08).
  
  
  RESULTS
  In the no-PDE-5i group, the mean baseline SHIM score of 17.1 decreased rapidly to 9.1 at 6 months (P= 0.01) and stayed at 9.3 at 12 months (P= 0.01). In the early PDE-5i group, the mean baseline SHIM score of 21.8 decreased slightly to 17.6 at 6 months (P= 0.2), and was maintained at 17.9 at 12 months (P= 0.2). Using the Wilcoxon rank-sum test, the 6- and 12-month SHIM scores in the two groups (P < 0.001). The IIEF-6 questionnaire confirmed the SHIM analysis.
  
  
  CONCLUSIONS
  After PB patients had a significant decline in SHIM/IIEF-6 scores at 6 and 12 months. Our results indicate a 50% decrease in the quality of their erections. This provides an opportunity to initiate early intervention with PDE-5i or perhaps vacuum constriction devices or intraurethral alprostadil. In this study, the early use of PDE-5i after PB maintained erectile function at both 6 and 12 months.
authors.affiliation: Glickman Urological and Kidney Institute, Department of Regional Urology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Geetu
authors.initials: G
authors.lastname: Pahlajani
authors.forename: Rupesh
authors.initials: R
authors.lastname: Raina
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.forename: Michael
authors.initials: M
authors.lastname: Burdick
authors.forename: Marwan
authors.initials: M
authors.lastname: Ali
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.forename: Arul
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Jay
authors.initials: J
authors.lastname: Ciezki
authors.forename: Craig
authors.initials: C
authors.lastname: Zippe
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D004812:Epidemiologic Methods; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate