1. Prostate Cancer Symposium An Educational Initiative For Patients, Spouses, Advocates and Healthcare Professionals Restoring Quality of Life: Managing Side-effects/Pain Control David Shin, MD Biren Saraiya, MD Supported by educational grants from: IN CONJUNCTION WITH

2. 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

3. 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)

4. 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

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

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

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

8. Treatment for ED: PDE 5 Inhibitors N H N N O O CH 3 O O H H Tadalafil NH N N N CH 3 CH 3 O O CH 3 S N N HC 3 O O Sildenafil NH N N N CH 3 O O CH 3 S N N O O CH 3 Vardenafil HC 3 ( Viagra ® ) (Levitra ® ) (Cialis ® )

9. Vacuum Erection Device Treatment of ED

10. Intraurethral suppository Treatment of ED

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

12. Inflatable Penile Prosthesis Treatment of ED

13. Penile Rehabilitation Success Rates after Radical Prostatectomy PDE V Inhibitors (86%): –Bannowsky et al. BJU Int 2008 101: 1279-83 –McCullough 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

14. 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