Phosphodiesterase-5 inhibitor use highest after laparoscopic/robotic prostatectomy

Boston-Radical prostatectomy patients are most likely to employ pharmacotherapy for erectile dysfunction in the immediate postoperative period, with those who undergo laparoscopic/robotic prostatectomy having the greatest rate of usage, say investigators from Brigham and Women's Hospital and Harvard Medical School here.

Results of their study came from 14,727 men who underwent prostatectomy between 2003 and 2005. The researchers assessed the use of pharmacotherapy for ED at baseline (up to 3 months prior to prostatectomy) and up to 18 months following surgery.

"It was interesting to find that men undergoing radical prostatectomy, particularly via the laparoscopic/robotic approach, were more likely to employ phosphodiesterase type-5 inhibitor therapy in the period 0 to 6 months postoperatively," said Michaella M. Prasad, MD, a urology resident at Brigham and Women's Hospital working with Jim C. Hu, MD, and colleagues. "This is somewhat surprising, considering the initial dip and plateau of sexual function 18 to 24 months postoperatively."

The majority of subjects (11,719) in the analysis underwent retropubic radical prostatectomy. A smaller proportion (2,352) received laparoscopic/robotic surgery, while 656 were treated with the perineal approach.

Mean age did not differ significantly by surgical approach (p>.05). Use of PDE-5 inhibitors was greater than that of injectable and alprostadil suppository (MUSE) therapies.

"There are reports in the literature of potency rehabilitation protocols that may be employed directly after surgery to enhance the recovery of erectile function using PDE-5 inhibitors," Dr. Prasad said during her presentation of study results at the AUA annual meeting in Orlando, FL. "However, there are no multicenter, randomized controlled trials demonstrating the effectiveness of these protocols."

PDE-5 usage patterns

Prior to surgery, subjects exhibited similar usage of PDE-5 inhibitors across surgical methods, with little use of injectable and suppository therapies. But usage increased significantly from baseline at the 6-, 12- and 18-month follow-up marks, with the greatest usage coming in the laparoscopic/robotic group at 6 months.

That probably comes as no surprise, Dr. Prasad said, considering the type of men who would consent to undergoing laparoscopic or robotic surgery.

"This is the cohort most likely to seek out and embrace 'new' techniques or approaches," she said. "Many would agree that the demand for laparoscopic or robotic radical prostatectomy is patient-driven and is influenced by market forces and direct-to-consumer advertising. It would be interesting to compare utilization of erectile dysfunction pharmacotherapy in our domestic health care system versus prescribing patterns in European countries in which direct-to-consumer advertising is currently prohibited."

Dr. Prasad also said that information found on the Internet, despite being uncensored and often unreliable, also drives patient pharmacotherapy choices when it comes to ED. She advised urologic surgeons to "preemptively address popular Internet content with patients and emphasize that unproven therapies potentially can be costly and have bothersome or harmful side effects."

A recent survey by the National Prostate Cancer Coalition suggested that the Internet was the most popular and trusted source of information for men with prostate cancer.