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

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

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

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

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 ® )

Vacuum Erection Device Treatment of ED

Intraurethral suppository Treatment of ED

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

Inflatable Penile Prosthesis Treatment of ED

Penile Rehabilitation Success Rates after Radical Prostatectomy PDE V Inhibitors (86%): –Bannowsky et al. BJU Int : –McCullough et al. J Sex Med : VED (17%): –Kohler et al. BJU Int : –Raina et al. Int J Impot Res : Intraurethral Suppository (74%): –Raina et al. BJU Int : Intracorporeal Injection Therapy (52%): –Mulhall et al. J Sex Med (4):

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