Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship

Abstract

Introduction: Erectile dysfunction (ED) following prostate cancer treatment is not uncommon and penile rehabilitation is considered the standard of care in prostate cancer survivorship (PCS), where both patient and his partner desire to maintain and/or recover pre-treatment erectile function (EF). There is a clinical interest in the role of regenerative therapy to restore EF, since existing ED treatments do not always achieve adequate results. Aim: To review regenerative therapies for the treatment of ED in the context of PCS. Materials and Methods: A review of the existing PubMed literature on low-intensity extracorporeal shockwave therapy (LIESWT), stem cell therapy (SCT), platelet-rich plasma (PRP), gene therapy, and nerve graft/neurorrhaphy in the treatment of ED and penile rehabilitation, was undertaken. Results: IESWT promotes neovascularization and neuroprotection in men with ED. While several systematic reviews and meta-analyses showed positive benefits, there is limited published clinical data in men following radical prostatectomy. Cellular-based technology such as SCT and PRP promotes cellular proliferation and the secretion of various growth factors to repair damaged tissues, especially in preclinical studies. However, longer-term clinical outcomes and concerns regarding bioethical and regulatory frameworks need to be addressed. Data on gene therapy in post-prostatectomy ED men are lacking; further clinical studies are required to investigate the optimal use of growth factors and the safest vector delivery system. Conceptually interpositional cavernous nerve grafting and penile re-innervation technique using a somatic-to-autonomic neurorrhaphy are attractive, but issues relating to surgical technique and potential for neural ‘regeneration’ are questionable. Conclusion: In contrast to the existing treatment regime, regenerative ED technology aspires to promote endothelial revascularization and neuro-regeneration. Nevertheless, there remain considerable issues related to these regenerative technologies and techniques, with limited data on longer-term efficacy and safety records. Further research is necessary to define the role of these alternative therapies in the treatment of ED in the context of penile rehabilitation and PCS.

Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program?

“…The easy use, the near absence of side effects, and the good results have allowed for the technique's rapid spread. However, many studies must be done to evaluate the safety and efficacy of LIESWT in vasculogenetic ED, but there are few contrasting studies that evaluate the efficacy of this technology in patients with ED post-PC treatment [51,56]. Even if the mechanism of action in not yet fully know, there is great interest in the use of SCT in ED.…”

“…Ten men did not require any PDE5-I therapy after the 6 month follow-up. No pain was reported during the treatment and no adverse events were noted during the follow-up [51]. There are several LIESWT machines (electromagnetic, electrohydraulic, and piezoelectric) with different types of shockwave energy [52].…”

Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options

“…A recent review, conducted by Chung, describes new emerging therapies which can be used to restore erectile function after prostate cancer treatments. The objectives of these therapies are to promote endothelial revascularization and neural regeneration [ 88 ]. These therapies include low-intensity extracorporeal shockwave therapy, stem cell therapy, platelet-rich plasma, gene therapy, hyperbaric oxygen, and nerve grafting [ 11 , 75 ].…”

Assessment of the intracavernosal injection platelet‐rich plasma in addition to daily oral tadalafil intake in diabetic patients with erectile dysfunction non‐responding to on‐demand oral PDE5 inhibitors

“…Several preclinical and clinical trials were designated in using autologous PRP for treating ED with a limitation of small groups and short follow‐up periods (Chung, 2021; Zaghloul et al, 2021). The main outcome measures for those preclinical trials on ED were erectile function, evaluated with intracavernosal pressure and histopathology of the cavernous tissue (Poulios et al, 2021; Wu et al, 2021).…”