Proactive rehab important for PCa patients with ED

Convincing patients to lose weight and treating them early with standard medical therapies for erectile dysfunction are two ways clinicians can help their patients return to sexual function after radical prostatectomy or radiotherapy for prostate cancer.

"There is more data gathering that the more proactive you get with daily Viagra or one of the other [phosphodiesterase type-5 inhibitors], the more likely erections are to return," Dr. Mulcahy said. "The rates are still very low but a lot better than doing nothing."

Dr. Mulcahy speculated that some unknown factor may influence erectile function, perhaps an accessory artery.

Erectile function is preserved at a greater rate initially after radiotherapy than after surgery, Dr. Mulcahy said, but the rate drops gradually due to endothelial hyperplasia as a result of the radiation and resulting loss of blood flow.

"A good number to keep in mind is 80% preservation in the first year [after radiotherapy], 20% preservation by the fifth year," he said.

As with post-surgical patients, treating for erectile dysfunction improves the chances of retaining erectile function, but again, therapy must begin early.

"Work with them by 8 months or a year and you're going to get them back [to having erections]," he said. "But after a year, what you see is what you get.

"And just on an aging basis they're going to deteriorate anyway," he continued.

A common pathway for lower urinary tract symptoms and erectile function is the alpha-adrenergic system, Dr. Mulcahy said, and researchers are trying to associate the two for possible combination therapies. He said he is reserving judgment on this possibility, because the real association between the two conditions may simply be one of aging.

Perhaps a more significant factor contributing to erectile dysfunction as well as a host of other diseases is metabolic syndrome, a symptom complex of high blood pressure, abnormal lipids, increased abdominal girth, obesity, and erectile dysfunction. Diabetes plays a strong role in metabolic syndrome as well.

"Losing weight, that is, treating obesity, appears to improve erections," Dr. Mulcahy said. "Obese people have a lot vascular problems, and erections are a vascular phenomenon."

Dr. Mulcahy does not foresee any dramatic advances in medical treatment of erectile dysfunction in the next few years.

Clinical trial data on dapoxetine, an investigational agent indicated for the treatment of premature ejaculation, will be presented at the meeting, he said. Dapoxetine is a serotonin transport inhibitor that may be a safer alternative to selective serotonin reuptake inhibitors for this common condition.

One news item that will likely be discussed at the meeting is the FDA's decision to change the alpha-blocker contraindication for tadalafil (Cialis) to a warning, Dr. Mulcahy said.