REVIEW: Utilization of Pharmacotherapy for Erectile Dysfunction Following Treatment for Prostate Cancer

Abstract

Introduction Pharmacotherapies improve sexual function following treatments for localized prostate cancer; however, patterns of care remain unknown. Aim To ascertain post-treatment utilization of pharmacotherapies for erectile dysfunction (ED) using a population-based approach. Methods We identified 38,958 men who underwent definitive treatment for localized prostate cancer during 2003–2006 from the MarketScan Medstat data. Main Outcome Measures We compared the use of ED pharmacotherapy at baseline (up to 3 months prior) and up to 30 months following radical prostatectomy (RP) or radiotherapy (RT) for localized prostate cancer by utilizing National Drug Classification codes for phosphodiesterase-5 inhibitors (PDE5I), intracavernosal injectable therapies (IT), urethral suppositories and vacuum erection devices (VED). In adjusted analyses, we controlled for the effect of age, comorbidity, type of treatment, health plan and use of adjuvant hormone therapy on the use of pharmacotherapies. Results Men undergoing RP vs. RT were younger with less co-morbid conditions. Utilization of PDE5I was up to three times greater for men undergoing RP vs. RT, 25.6% vs. 8.8%, (P <0.0001) in the first post-treatment year, and usage of these agents was greatest for men undergoing minimally-invasive RP procedures. A higher percentage of men also used IT, suppositories and VED after RP vs. RT (P <0.001). However, more men in the RT group received adjuvant hormonal therapy (39.53% vs. 5.25% for RP, P <0.01). In adjusted analyses, men undergoing RP vs. RT were more than two times likely (OR 2.1, 95% CI 1.98, 2.26) to use PDE5I post-treatment while men on adjuvant hormonal therapy were less likely to use PDE5I (OR 0.74, 95% CI 0.70–0.79, P <0.0001). Conclusion Men undergoing RP vs. RT, particularly minimally-invasive RP, are more likely to employ IT, suppositories, VED, and PDE5I pharmacotherapy post-treatment.

Defining Young in the Context of Prostate Cancer

“…Several studies have described long term erectile difficulties in excess of 80% of men diagnosed and treated for prostate cancer (Fujita, Landis, McNeil, & Pavlovich, 2009; Johansson et al, 2011; Kyrdalen, Dahl, Hernes, Smastuen, & Fossa, 2013), and given the steady increase in prostate cancer internationally this presents as an enormous looming men’s health problem (Baade et al, 2009). While medical treatments for erectile dysfunction remain the mainstay of treatment, many men do not seek these therapies after treatment, and if they do longer term maintenance of treatment is poor (Kimura et al, 2012; Pahlajani, Raina, Jones, Ali, & Zippe, 2012; Prasad et al, 2010). Further, while sexual rehabilitation approaches appear effective, limited uptake and high attrition are problematic (Schover et al, 2012).…”

A randomized trial of internet‐based versus traditional sexual counseling for couples after localized prostate cancer treatment

“…Not only are rates of erectile dysfunction (ED) higher than estimates from more selected cohorts,3, 4, 7 but medical treatments for ED after prostate cancer have had poor success rates and dismal adherence over time 8‐11. Men are far more likely to receive ED treatments after radical prostatectomy than after radiation therapy 8‐10, 12. In a population‐based study of almost 39,000 prostate cancer survivors, only approximately 26% of men tried oral medication after radical prostatectomy, and 11% tried such medication after radiation therapy 12…”

“…Men are far more likely to receive ED treatments after radical prostatectomy than after radiation therapy 8‐10, 12. In a population‐based study of almost 39,000 prostate cancer survivors, only approximately 26% of men tried oral medication after radical prostatectomy, and 11% tried such medication after radiation therapy 12…”

Managing Erectile Dysfunction After Cancer: More Than Penile Rigidity

“…In a study of 39,000 Medicare patients treated for localized prostate cancer, a PDE5i was used by 26% in the first year after radical prostatectomy but only 9% after radiation therapy. 6 Studies of patients with prostate cancer in academic medical centers show that 38% to 52% of men try a PDE5i, but only 7% to 18% use penile injection therapy, 5% to 19% use a vacuum erection device, 4% to 10% try a urethral suppository, and 2% have penile prosthesis surgery. 2 Unfortunately, these studies agreed that continued use of all treatments other than the penile prosthesis was well below 50% after several months.…”