Ihor Sawczuk Sent separately 1 st presentation Prostate

Ihor Sawczuk • Sent separately (1 st presentation): Prostate Cancer 101: Testing & treatment Stanley H. Weiss, MD 1

Men’s Health: Optimizing Erectile Function after Prostate Cancer Treatment David Shin, M. D. Chief, Center for Sexual Health & Fertility Department of Urology Hackensack University Medical Center

Erectile Dysfunction after Prostate Cancer Treatment • Surgery (27 -43%) – Open – Laparoscopic – Robotic • Radiotherapy (38 -62%) – Conventional – 3 -D Conformal Radiotherapy (CRT) – Intensity Modulated Radiotherapy (IMRT) • Brachytherapy (30 -53%) – Iodine-125 (I-125) – Palladium-103 (Pd-103)

Penile Rehabilitation • Goal: – Incorporate preventative measures to preserve erectile function after prostate cancer treatment • Concept: – Improve Cavernosal Oxygenation – Promote Endothelial Protection – Prevent cavernosal nerve injury-induced structure changes • Expectations

Penile Rehabilitation: Treatment Options • • • Phosphodiesterase (PDE) V Inhibitors Vacuum-assisted Erection Device (VED) Intraurethral Suppository Intracorporeal Injections Surgery: Penile Prosthesis

Treatment Options for ED Intraurethral therapy Vacuum device/rings Oral therapy Talk therapy/ sexual counselling Penile implants Injection therapy

Treatment for ED: PDE 5 Inhibitors O O N N HN O CH 3 N S N N O CH 3 Sildenafil CH 3 (Viagra ) ® (Cialis ) ® (Levitra ) ®

Treatment of ED Vacuum Erection Device

Treatment of ED Intraurethral suppository

Treatment of ED Intracavernosal Injection Therapy ® Caverject (Alprostadil) ® Trimix (PGE, Phentolamine, Papaverine)

Treatment of ED Inflatable Penile Prosthesis

Penile Rehabilitation Success Rates after Radical Prostatectomy • PDE V Inhibitors (86%): – Bannowsky et al. BJU Int 2008 101: 1279 -83 – Mc. Cullough et al. J Sex Med 2008 5: 476 -83 • VED (17%): – Kohler et al. BJU Int 2007 100: 858 -62 – Raina et al. Int J Impot Res 2006 18: 77 -81 • Intraurethral Suppository (74%): – Raina et al. BJU Int 2007 100: 1317 -21 • Intracorporeal Injection Therapy (52%): – Mulhall et al. J Sex Med 2005 2(4): 532 -40

Penile Rehabilitation: HUMC Protocol • 2 WEEKS PRIOR TO SURGERY: – Sildenafil 25 mg every night • AFTER SURGERY: – Resume sildenafil 25 mg every night after catheter removal • 1 MONTH AFTER SURGERY: – Sildenafil 25 mg every night + sildenafil 100 mg prior to intercourse – Start Vacuum-assisted erection device 5 -10 min/day • 3 MONTHS AFTER SURGERY: – Incorporeal injection therapy or intraurethral suppository therapy if above regimen is ineffective