title: Androgen deprivation therapy before radical prostatectomy is associated with poorer postoperative erectile function outcomes.
abstract: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Erectile dysfunction is a recognized complication of radical prostatectomy. Androgen deprivation therapy adversely impacts sexual function. Our study shows that the preoperative use of androgen deprivation therapy significantly reduces erectile function recovery after radical prostatectomy. The underneath pathophysiological mechanisms for this to occur are reviewed.
  
  
  OBJECTIVE
  To define the impact of androgen deprivation therapy (ADT), undergone before radical prostatectomy (RP), on erectile function (EF) recovery.
  
  
  METHODS
  A total of 38 consecutive patients presenting to a sexual medicine clinic after undergoing RP who had received ADT before RP (ADT+ group) were compared with a contemporary, age and comorbidity-matched cohort of 94 patients who did not receive ADT (ADT- group) before undergoing RP. Medical records were reviewed for demographics, comorbidity profiles and duration of ADT exposure. All the patients underwent Doppler penile ultrasonography within 6 months of RP and were administered the International Index of Erectile Function (IIEF) questionnaire. All the patients underwent evaluation of EF recovery. We analysed the incidence of venous leak (VL), mean IIEF EF domain score and proportion of men with EF domain scores ≥ 24 at 18 months after RP.
  
  
  RESULTS
  The mean age, comorbidity profiles, median Gleason score, median pre-treatment PSA level, and mean time to evaluation after RP were similar between the two groups. The median duration of ADT exposure in the ADT+ group was 3 months. The incidence of VL within 6 months of surgery was 60% for the ADT+ and 20% for the ADT- group (P < 0.001). Likewise, the IIEF EF domain scores and proportion of men with EF domain scores ≥ 24 at 18 months were significantly lower in the ADT+ group, even when controlled for nerve-sparing status.
  
  
  CONCLUSIONS
  Our data suggest that preoperative use of ADT adversely impacts EF outcomes and should therefore be avoided in the absence of robust data suggesting any oncological benefit.
authors.affiliation: Sexual and Reproductive Medicine Program, Urology Department, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Clarisse R
authors.initials: CR
authors.lastname: Mazzola
authors.forename: Serkan
authors.initials: S
authors.lastname: Deveci
authors.forename: Matthias
authors.initials: M
authors.lastname: Heck
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects*; D011300:Preoperative Care; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000601:surgery*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D058986:Phosphodiesterase 5 Inhibitors; D016729:Leuprolide