title: Prophylactic sildenafil citrate improves select aspects of sexual function in men treated with radiotherapy for prostate cancer.
abstract: OBJECTIVE
  We studied adjuvant daily sildenafil citrate during and after radiotherapy for prostate cancer for erectile function preservation.
  
  
  METHODS
  We performed a randomized, prospective trial of 279 patients with localized prostate cancer treated with radiotherapy who received sildenafil citrate (50 mg daily) or placebo (2:1 randomization). Medication/placebo was initiated 3 days before treatment and continued daily for 6 months. Before therapy and 3, 6, 9, 12, 18 and 24 months after radiotherapy patients completed the IIEF questionnaire, including the erectile function domain, the I-PSS questionnaire and the RAND SF-36®. All IIEF domains were scored.
  
  
  RESULTS
  At 12 months erectile function scores were better for sildenafil citrate than placebo (p = 0.018), 73% of patients on sildenafil citrate vs 50% on placebo had mild/no erectile dysfunction (p = 0.024) and the sildenafil citrate arm had superior overall satisfaction (p = 0.027) and IIEF total scores (p = 0.043). At 24 months erectile function and IIEF scores were no longer significantly better for sildenafil citrate (p = 0.172 and 0.09, respectively) and yet overall satisfaction scores were higher (p = 0.033). Sexual desire scores in patients who received sildenafil citrate were higher at 24 months although they had completed drug therapy 18 months previously (p = 0.049). At 24 months 81.6% of patients on sildenafil citrate and 56.0% of those on placebo achieved functional erection with or without erectile dysfunction medication (p = 0.045).
  
  
  CONCLUSIONS
  Daily sildenafil citrate during and after radiotherapy for prostate cancer was associated with improved overall sexual function compared with placebo for various sexual function domains. To our knowledge this is the largest randomized, prospective, controlled trial to show the usefulness of a phosphodiesterase-5 inhibitor as a rehabilitation strategy in patients with prostate cancer who received radiation therapy.
authors.affiliation: Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: zelefskm@mskcc.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Radiation Oncology, Continuum Cancer Center of New York, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shasha
authors.affiliation: Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Rebekah Dunn
authors.initials: RD
authors.lastname: Branco
authors.affiliation: Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Marisa
authors.initials: M
authors.lastname: Kollmeier
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Baser
authors.affiliation: Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Xin
authors.initials: X
authors.lastname: Pei
authors.affiliation: Department of Radiation Oncology, Continuum Cancer Center of New York, New York, New York.
authors.forename: Ronald
authors.initials: R
authors.lastname: Ennis
authors.affiliation: Departments of Radiation Oncology and Urology, Mt. Sinai Medical Center, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Stock
authors.affiliation: Departments of Radiation Oncology and Urology, Mt. Sinai Medical Center, New York, New York.
authors.forename: Natan
authors.initials: N
authors.lastname: Bar-Chama
authors.affiliation: Departments of Radiation Oncology and Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011687:Purines / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate
keywords: erectile dysfunction; prostate; prostatic neoplasms; radiotherapy; sildenafil