Abstract
Prostate cancer is relatively common cancer occurring in males. Radical prostatectomy (RP) is the most effective treatment for a localized tumor but erectile dysfunction (ED) is common complication, even when bilateral nerve-sparing RP (BNSRP) is performed. Clinical trials have shown varied effectiveness of phosphodiesterase type-5 inhibitors (PDE5-Is) for treatment of post-BNSRP ED, but there remains controversy over the application of this treatment and no formal systematic review and meta-analysis for the use of PDE5-Is for this condition has been conducted. This review was to systematically assess the efficacy and safety of oral PDE5-Is for post-BNSRP ED. A database search was conducted to identify randomized controlled trials (RCTs). The comparative efficacy of treatments was analyzed by fixed or random effect modeling. Erectile function was measured using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP) question-2, 3 and the Global Assessment Question (GAQ). The rate and incidence of adverse events (AEs) were determined. The quality of included studies was appraised using the Cochrane Collaboration bias appraisal tool. Eight RCTs were included in the analyses. PDE5-Is were effective for treating post-BNSRP ED compared to placebo when erectile function was determined using the IIEF score [mean difference (MD) 5.63, 95% confidence interval (CI) (4.26–6.99)], SEP-2 [relative risk (RR) 1.63, 95% CI (1.18–2.25) ], SEP-3 [RR 2.00, 95% CI (1.27–3.15) ] and GAQ [RR 3.35, 95% CI (2.68–4.67) ]. The subgroup analysis could find a trend that longer treatment duration, higher dosage, on-demand dosing, sildenafil and mild ED are associated with more responsiveness to PDE5-Is. PDE5-Is were overall well tolerated with headache being the most commonly reported AE. Our data provides compelling evidence for the use of PDE5-Is as a primary treatment for post-BNSRP ED. However, further studies are required to optomize usage parameters (such as dosage and duration of treatment).
Highlights
Prostate cancer is a relatively prevalent disease, and in some Western countries it is the leading type of malignant tumor diagnosed in males [1]
There were no original clinical trials studied the new generation of phosphodiesterase type-5 inhibitors (PDE5-Is) for post-radical prostatectomy (RP) Erectile dysfunction (ED)
This study showed that the improvement of ED by PDE5-Is negatively related to the severity of ED (IIEF score increased by 5, 4.7 and 4.5 for mild, moderate and severe ED groups, respectively)
Summary
Prostate cancer is a relatively prevalent disease, and in some Western countries it is the leading type of malignant tumor diagnosed in males [1]. The prognosis is good, with a 5year relative disease-specific survival rate of approximately 100% for patients who undergo localized cancer treatment by radical prostatectomy (RP) [2]. Many factors influence the incidence and severity of postoperative ED, including patient age, tumor stage, preoperative potency, length of time following surgery and the experience of surgeon [8,9,10,11,12]. The pathophysiology of post-RP ED mainly results from three causes; neural injury, vascular injury, and smooth muscle damage [13,14]. Vascular injury primarily involves damage to the accessory pudendal arteries. It has been well documented in several studies that smooth muscle and endothelium undergo structural changes resulted from neurapraxia [15]. Smooth muscle apoptosis and upregulation of collagen expression are the primary conditions resulting in venous leak [16,17,18]
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