Does “penile rehabilitation” really work?


A new review in BJU International looks carefully at the evidence for use of phosphodiesterase type 5 (PDE5) inhibitors (e.g., Viagra and Cialis), prostaglandins, and vacuum erection devices in “penile rehabilitation” after first-line treatment for localized prostate cancer.

To quote the authors (Fode et al.), “One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing.”

What is true is that:

  • Different types of treatment can help some men to recover or improved their erectile function after first-line treatment.
  • Currently available forms of penile rehabilitation quite certainly does not help all men in this way.
  • The largest randomized clinical trial carried out to date found no long-term benefit from the use of daily or on-demand PDE5 inhibitor therapy compared to a placebo after radical prostatectomy .
  • Data from large clinical trials on the effects of prostaglandin and vacuum erection devices in men after first-line treatment for localized prostate cancer are missing.

Having said that, for men who are eager to optimize their chances of recovery of good erectile and sexual function after first-line treatment for prostate cancer, the above-mentioned forms of intervention are what we have available today … and some men do appear to benefit from their use.

The important thing for patients to understand going in is that our ability to affect recovery of erectile function after a radical prostatectomy (and probably after other forms of treatment too)  is limited. One certainly should not be expecting any type of dramatic response to penile rehabilitation … but some hope is not unreasonable under the right circumstances.

Men diagnosed today with low-risk prostate cancer should be made very clearly aware that treatment of any type may affect their erectile and sexual funcion and that active monitoring of some type may allow them to defer immediate treatment in either the short-term or potentially the long-term, thereby deferring risk for loss of or decline in sexual ability  … particularly if their sexual function is a key factor to their happiness and quality of life.

The bottom line is that we need better ways to address the problems of loss of erectile function after first-line treatment for prostate cancer … and men need to appreciate before their treatment that the majority of first-line treatments for localized prostate cancer are associated with some degree of loss or decline in erectile and sexual function either immediately or over time (although in the latter case this is always complicated by the fact that some loss of erectile and sexual function is an almost inevitable part of the aging process).

One Response

  1. Those who are interested in the above paper may also be interested in a recent paper by Kukola et al. on “Eroticization as a factor influencing erectile dysfunction treatment effectiveness.” If you want to read a complete copy of that paper, you can e-mail the senior author, Dr. Richard Wassersug.

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