THE "NEW" PROSTATE CANCER INFOLINK

A review article published last September on the relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has just been defined by Faculty of 1000 Medicine as “changing clinical practice.”

For readers who may not be familiar with the term LUTS, it is a widely used term in urology, describing a broad range of symptoms characteristic of difficulties with urination, and commonly associated with onset of benign prostatic hyperplasia (BPH).

While we thought this article by Köhler and McVary was certainly interesting, we did not report on it at the time because it was not specific to prostate cancer. However, the recommendation that this article is “practice changing” may have significant implications for how clinicians look at the management of ED in relation to LUTS and therefore the clinical use of phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra) and others in patients with prostate cancer too.

In their article, the authors set out to review the current literature on the LUTS-ED relationship and the role of PDE5 inhibitors from both a basic science and clinical intervention perspective. They focused exclusively on data published  between 1990 and 2008 that described epidemiologic and mechanistic aspects of the relationship between LUTS and ED, placing emphasis on articles that addressed the  use and applicability of PDE5 inhibitors and most particularly on articles providing level 1 evidence clinical trials.

They go on to make the following key points:

• There is a significant concurrence of LUTS and ED in older men that likely stems from a cause-and-effect relationship.
• To date, four mechanisms have been proposed in attempts to explain the relationship between LUTS and ED.
• Multiple studies have shown clearly that PDE5 inhibition can improve LUTS.
• Understanding of the role of PDE5 inhibition in the relationship between LUTS and ED affects patient assessment and treatment (in addition to raising further research questions).

The authors conclude that, “The future use of phosphodiesterase inhibitors as either prophylaxis or as a primary treatment for LUTS looms as a possibility and may not be limited to men.”

Why do we think that the heightened visibility of this paper may be important to management of prostate cancer? Basically for the following reasons:

• Many men with prostate cancer may have mild or serious LUTS both before and after treatment for prostate cancer.
• The suggestion in this paper that PDE5 inhibitors like Viagra can be used “as either prophylaxis or as primary treatment for LUTS” adds weight to the expanding (but still not widespread) use of PDE5 inhibitors before during, and after primary treatment of prostate cancer, as a means to prevent post-treatment ED.

We would further note the possibility (in the USA) that this may lead to expansion of coverage for the prescription of PDE5 inhibitors.

Filed under: Living with Prostate Cancer, Management, Treatment Tagged: | ED, LUTS, PDE5 inhibitor