UroToday - Phosphodiesterase Type 5 Inhibitors in the Management of Erectile Dysfunction Secondary to Treatments For Prostate Cancer: Findings from a Cochrane Systematic Review

June 6, 2008

Thursday, 05 June 2008

BERKELEY, CA

(UroToday.com) - A group from the UK led by Bridget Candy report a

meta-analysis in the BJU International on phosphodiesterase type 5 inhibitors

(PDE5i) for the treatment of erectile dysfunction (ED) secondary to treatments

for prostate cancer (CaP).

Only

randomized controlled trials were included and outcomes using validated scales

such as the IIEF and SEP, successful sexual intercourse, time to effect,

treatment satisfaction and health-related QOL were extracted. Of 10,340

citations, only 5 met full inclusion criteria for this review. In total, 959

men participants were included, 2 trials were multi-centered, 2 were cross-over

designs, and all were pharmaceutical company funded. Two trials evaluated the

effects of sildenafil, 2 tadalafil and one vardenafil. Most were at the highest

recommended doses of these drugs. The authors rate the design of the 5 trials

as fair. Attrition bias in the studies was 13-25%.

In all

trials the PDE5i drugs were significantly favored over placebo. In 2 trials the

combined odds ratio for improvement in erections was 10.09. In one trial the OR

from successful intercourse was 2.88. All trials had reported side effects,

most commonly dyspepsia, flushing, headache, nausea and rhinitis. In combined

data from 2 trials totaling 513 patients, significantly fewer patients

receiving the PDE5i withdrew secondary to inefficacy. In one trial, the

effectiveness of the PD5i by dosage and unilateral vs. bilateral nerve sparing

radical prostatectomy found no difference.

Candy B,

L, R, Tookman A, King M

BJU

Int. 2008 Apr 10 (Epub ahead of print)

doi: 10.1111/j.1464-410X.2008.07668.x

PubMed

Abstract

PMID: 18410431

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