Alpha-blocker shows efficacy in ejaculatory dysfunction

Senior author Raymond Rosen, PhD, presented data from Alf-Life, a large, international trial assessing the effect of once-daily alfuzosin on EjD.

"Of all the available treatment options for LUTS, alfuzosin has the unique benefit of treating both LUTS and the ejaculatory dysfunction that often accompanies it," said Dr. Rosen, chief scientist at New England Research Institutes, Watertown, MA.

Improvements in EjD, LUTS

As expected, significant improvements were also seen in LUTS from alfuzosin treatment. IPSS decreased by 7.9 points (p<.0001) and bother score decreased by 1.5 points (p<.0001) compared to baseline, Dr. Rosen reported at the 2010 European Association of Urology annual congress in Barcelona, Spain. The percentage of men experiencing nocturia three or more times per night decreased from 48% to 16%. All of these findings were statistically significant.

Alfuzosin was well tolerated, as only 3% of men discontinued the treatment due to adverse events. The main adverse event was dizziness in 2%, with very low rates of hypotension (0.1%) and no syncope. Sexual adverse events were also rare, with erectile dysfunction and abnormal ejaculation occurring in 0.1% and 0.2%, respectively.

The mechanism behind the improvements in EjD is still unknown. It also remains unclear whether the EjD seen in men with BPH is due to anejaculation or retrograde ejaculation. Considering that other alpha-blockers worsen EjD, the differences with alfuzosin are currently being studied.

A lengthy discussion of this issue took place at the EAU congress following the presentation, with Dr. Rosen suggesting that it was likely related to central nervous system effects, rather than effects on the prostate itself. Current research implicates increased CNS levels of serotonin, he said, but further study is needed.

Placebo-controlled trials needed

One criticism of the trial was the absence of a placebo-control arm. While the effect size was large, such controls are needed to ensure that the findings were not related to the placebo effect.

"Placebo-controlled trials are required to confirm the benefit of alfuzosin on ejaculatory dysfunction," Dr. Rosen said.

In the trial, ejaculatory function was measured using a validated instrument, the Male Sexual Health Questionnaire related to Ejaculatory Dysfunction (MSHQ-EjD). This questionnaire evaluates bother associated with ED and three aspects of ejaculatory function: the ability to ejaculate during sex and the force and volume of ejaculation.

Dr. Rosen has served in the past as a research consultant to sanofi-aventis, but has no current financial relationship to the company.