An unfortunately misleading statement in the AFP

Back in 2014, the American Cancer Society (ACS) issued a really rather thorough set of guidelines on the long-term management of survivors after initial treatment for prostate cancer.

This original article by Skolarus et al. is detailed; its application is highly dependent (rather obviously) on the precise diagnosis and initial treatment of the individual patient; and it makes the assumption (and the recommendation) that follow-up care for such patients should, in fact, generally be managed by an appropriate specialist or a subspecialist , e.g., a urologist, a urologic concologist, a medical oncologist, etc.

The truth, however, is that many prostate cancer survivors — particularly in the more rural areas of America — return to the care of their primary care provider. And for such primary care providers the ACS guidelines can be hard to apply and perhaps even difficult to follow. Thus, it is gratifying to see the publication of an article by Noonan and Farrell in the very widely read journal American Family Physician (AFP). This new article states explicitly that it is “a summary” of the ACS prostate cancer survivorship care guidelines.

Unfortunately, at least in the opening paragraphs, it contains a highly misleading statement that reads as follows:

A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer.

Strictly of course, this statement is true. A PDE-5 inhibitor like sidenafil (Viagra) or tadalafil (Cialis) can effectively be used to treat sexual dysfunction in prostate cancer survivors … but only in a relatively select group of those survivors. Based on the information we have seen, the value of such treatment is limited — and non-existant for many men; furthermore, such treatment is commonly not covered by either Medicare or by commercial insurers — even for men who have had prostate cancer.

The information in the original article by Skolarus et al. on this use of PDE-5 inhibitors is much more nuanced, and states only that

Erectile dysfunction may be addressed through a variety of options, including penile rehabilitation or prescription of phosphodiesterase type 5 inhibitors (e.g., sildenafil, vardenafil, tadalafil).

There is clearly a wide margin for misunderstanding between this statement and the one above, and the average primary care physician already has a high mountain of new information to try to keep on top of in caring for all his or her patients.

If the statement in the article by Noon and Farrell had read as follows, we wouldn’t have said a word:

A phosphodiesterase type 5 inhibitor may be effective in the treatment of sexual dysfunction following treatment for prostate cancer.

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