A paper presented earlier this week at the annual meeting of the American Urological Association in Atlanta suggests that a drug called cabergoline may have the ability to induce the return of orgasm in men with anorgasmia (the persistent or frequent absence of orgasm after normal sexual arousal). The available data suggests that the patients included men with anorgasmia as a consequence of radical prostatectomy.
Hsieh et al. report data from a series of 107 men treated with cabergoline (o.5 mg twice a week) at a single, specialized andrology clinic (click here and search for abstract no. 1495) . Additional information about this study is available on the MedPage Today web site.
Of these 107 men, 35 were excluded from the analysis because they received cabergoline for treatment of conditions other than anorgasmia.
Analysis of data from the remaining 72 men, all treated for anorgasmia, showed the following:
- 50/72 anorgasmic patients (69 percent) showed improvement of orgasm.
- 26/50 men who responded to cabergoline therapy (52 percent) returned to having normal orgasms after therapy.
- Duration of cabergoline therapy and duration of concomitant testosterone replacement therapy were associated with a significant response to treatment (p = 0.02 and 0.03, respectively).
- Average (mean) duration of therapy for non-responders and responders to cabergoline was 214 and 296 days, respectively.
- No differences in efficacy were found between topical and injectable forms of testosterone replacement therapy.
- Neither patient age nor prior radical prostatectomy influenced outcome of cabergoline treatment (p = 0.9 and 0.42, respectively).
Adverse effects of cabergoline therapy include psychological effects as well as drug-related and post-prostatectomy sequela, and a surge in prolactin levels has been observed during the post-ejaculatory refractory period, decreasing erectile and ejaculatory potential.
Hsieh et al. suggest that the inhibitory effect of cabergoline on prolactin levels may be a desired endpoint in the treatment of male anorgasmia.
As far as The “New” Prostate Cancer InfoLink is aware, this is the first report of cabergoline (or any drug) having activity as a treatment for male anorgasmia — let alone male anorgasmia in patients after radical prostatectomy.
It will be apparent that these data come from a small, non-randomized case series, and therefore should be interpreted as “hypothesis generating.” A great deal more data would be necessary to provide clear evidence that cabergoline + testosterone replacement therapy might be an effective and safe form of treatment for anorgasmia after radical prostatectomy.
Filed under: Management, Living with Prostate Cancer Tagged: | radical prostatectomy, orgasm, cabergoline, anorgasmia
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Just one more excuse to not stop over-treating men.
There is another way to look at this Tracy, which is that it is possibly a way to help those men who insist on having treatment, regardless of advice to the contrary, and then end up with complications that they may never have needed to suffer from.
The decision to get treated is often one that is pressed by the patient and/or his family, over the best advice of the urologist.
This is a non-controlled study, and considering that the men were on the drug for nearly a year before an effect was noticed, it would be hard to conclude anything but that they recovered their libido naturally with time. It had been hoped that apomorphine, a more potent dopamine agonist than cabergoline or the earlier bromocryptine, would be better for libido. This didn’t turn out to be the case in studies in the UK. I suspect that pramipexole, a non-ergot dopamine (D3) agonist used for Parkinsonism, may turn out to be a better choice. There is strong evidence for the association between dopamine agonism and libido.
Thankfully, this is one side-effect of RP I somehow missed out on.