Mohit Khera, MD, MBA, MPH, presented “Recovering Sexual Function After Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.
How to cite: Khera, Mohit “Recovering Sexual Function After Prostate Cancer” January 25, 2019. Accessed Jul 2020. https://grandroundsinurology.com/recovering-sexual-function-after-prostate-cancer/
Recovering Sexual Function After Prostate Cancer
Mohit Khera, MD, MBA, MPH, reviews current practices for treatment of erectile dysfunction, including timing of therapy after radical prostatectomy, risk factors for penile rehabilitation, and the current American Urological Association (AUA) guidelines.
Treatment of erectile dysfunction (ED) used to begin with a PD5 inhibitor, such as Viagra. However, current practice uses shared decision making, which gives the patient options in their treatment plan. In shared decision making, physicians explain available treatment options, and the patient is given a choice of which treatment plan to use. In some cases, this means skipping the PD5 inhibitor and going straight to an injection, or even a penile implant.
Regardless of the choice, there can be certain complications with the timing of treatment. Dr. Khera discusses the risks of waiting to treat ED, which can lead to negative results such as venous leak and even a lack of success in treatment. A study of biopsies before and after radical prostatectomy (RP) showed the importance of quick treatments. Patients who do not get immediate treatment may experience venous leak at 14% at four months, 30% at 8 months, and 50% at 12 months. Risk factors for failure of natural erections returning after RP include age, trimis dose of >0.50cc, presence of one or more vascular comorbidity, and commencement of penile rehabilitation over six months post RP.
Additionally, there is conflicting evidence on the effectiveness of PD5 inhibitors. The 2018 AUA ED guidelines for penile rehabilitation state that early use of PD5 inhibitors after radical prostatectomy may not improve unassisted erectile function. Testosterone may aid the ED process, but currently it is not used as a monotherapy. However, the combination of PD5 inhibitors and testosterone may show better results, according to the AUA guidelines.
About the International Prostate Cancer Update
The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Khera presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.