This protocol addresses men who develop erectile dysfunction following radical prostatectomy or curative pelvic surgery for prostate cancer and who have not achieved adequate recovery on first-line pro-erectile treatment.
The patient has a history of radical prostatectomy or other curative pelvic surgery for prostate cancer. Pro-erectile treatment was initiated early after surgery, as recommended, including oral PDE5 inhibitor therapy — daily sildenafil being the most studied penile rehabilitation strategy — with or without a vacuum erection device.
The previous line — early initiation of pro-erectile treatment including oral PDE5 inhibitor therapy, with or without a vacuum erection device — did not result in recovery of erectile function sufficient for satisfactory intercourse. This protocol defines the structured next step for that failure scenario.
When oral PDE5 inhibitor therapy has proved inadequate in this post-surgical population, intracavernous injection therapy is the evaluated intervention. The complete regimen — agents, combinations, and clinical algorithm — is available in the full structured protocol.
Achievement of a rigid erectile response sufficient for satisfactory intercourse.
PDE5Is have been considered as the first-line therapy in patients who have undergone nerve-sparing surgery, regardless of the surgical technique used.
Start pro-erectile treatments at the earliest opportunity after radical prostatectomy/pelvic surgery and other curative treatments for PCa.
An updated meta-analysis including 22 trials comparing 16 different rehabilitation protocols, showed that daily administration of sildenafil 100mg was the most effective strategy to recover EF after RP.
Intracavernous injections and penile implants had been suggested as second- and third-line treatments, respectively, when oral PDE5Is are not adequately effective or not suitable for postoperative patients.
Efficacy is defined as an erection, with rigidity, sufficient for satisfactory intercourse.
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