Prostate Cancer Symposium

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IN CONJUNCTION WITH
Prostate Cancer Symposium
An Educational Initiative For Patients, Spouses,
Advocates and Healthcare Professionals
Restoring Quality of Life Managing
Side-effects/Pain Control David Shin, MD Biren
Saraiya, MD
Supported by educational grants from
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Mens HealthOptimizing Erectile Function after
Prostate Cancer Treatment
David Shin, M.D. Chief, Center for Sexual Health
Fertility Department of Urology Hackensack
University Medical Center
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Erectile Dysfunction after Prostate Cancer
Treatment

• Surgery (27-43)
• Open
• Laparoscopic
• Robotic
• Radiotherapy (38-62)
• Conventional
• 3-D Conformal Radiotherapy (CRT)
• Intensity Modulated Radiotherapy (IMRT)
• Brachytherapy (30-53)
• Iodine-125 (I-125)
• Palladium-103 (Pd-103)

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Penile Rehabilitation

• Goal
• Incorporate preventative measures to preserve
  erectile function after prostate cancer treatment
• Concept
• Improve Cavernosal Oxygenation
• Promote Endothelial Protection
• Prevent cavernosal nerve injury-induced structure
  changes
• Expectations

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Penile Rehabilitation Treatment Options

• Phosphodiesterase (PDE) V Inhibitors
• Vacuum-assisted Erection Device (VED)
• Intraurethral Suppository
• Intracorporeal Injections
• Surgery Penile Prosthesis

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Penile Rehabilitation Treatment Options

• Phosphodiesterase (PDE) V Inhibitors
• Vacuum-assisted Erection Device (VED)
• Intraurethral Suppository
• Intracorporeal Injections
• Surgery Penile Prosthesis

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Treatment Options for ED
Oral therapy
Intraurethral therapy
Talk therapy/sexual counselling
Vacuum device/rings
Injection therapy
Penile implants
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Treatment of ED
Vacuum Erection Device
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Treatment of ED
Intraurethral suppository
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Treatment of ED
Intracavernosal Injection Therapy
Caverject (Alprostadil)
Trimix (PGE, Phentolamine, Papaverine)
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Treatment of ED
Inflatable Penile Prosthesis
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Penile Rehabilitation Success Rates after Radical
Prostatectomy

• PDE V Inhibitors (86)
• Bannowsky et al. BJU Int 2008 101 1279-83
• McCullough et al. J Sex Med 2008 5 476-83
• VED (17)
• Kohler et al. BJU Int 2007 100 858-62
• Raina et al. Int J Impot Res 2006 18 77-81
• Intraurethral Suppository (74)
• Raina et al. BJU Int 2007 100 1317-21
• Intracorporeal Injection Therapy (52)
• Mulhall et al. J Sex Med 2005 2(4) 532-40

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Penile RehabilitationHUMC Protocol

• 2 WEEKS PRIOR TO SURGERY
• Sildenafil 25 mg every night
• AFTER SURGERY
• Resume sildenafil 25 mg every night after
  catheter removal
• 1 MONTH AFTER SURGERY
• Sildenafil 25 mg every night sildenafil 100 mg
• prior to intercourse
• Start Vacuum-assisted erection device 5-10
  min/day
• 3 MONTHS AFTER SURGERY
• Incorporeal injection therapy or intraurethral
  suppository therapy if above regimen is
  ineffective