Ohebshalom Michael, Parker Marilyn, Guhring Patricia, Mulhall John P
Departments of Urology, Weill Medical College of Cornell University, New York, New York, USA.
J Urol. 2005 Jul;174(1):258-62; discussion 262. doi: 10.1097/01.ju.0000164286.47518.1e.
Erectile dysfunction is a recognized complication of radiation therapy for prostate cancer. Sildenafil citrate is a well-known management strategy for erectile dysfunction that has been found to be efficacious across a wide spectrum of comorbidities, including post-radiation erectile dysfunction. We defined the efficacy of sildenafil citrate in patients with erectile dysfunction following radiation therapy for prostate cancer and assessed the impact of the interval after radiation on the success of this therapy.
Baseline and followup data on 110 patients presenting with erectile dysfunction secondary to radiation for prostate cancer was obtained. A total of 68 patients underwent 3-dimensional conformal external beam irradiation (CRT), while 42 underwent brachytherapy (BT) without androgen deprivation. All patients were considered to have erectile dysfunction after radiotherapy, as assessed by the International Index of Erectile Function (IIEF), and they were prescribed sildenafil citrate. Mean time +/- SD between the completion of radiation therapy and the initiation of sildenafil was 8 +/- 4 months. The response to sildenafil was assessed using the IIEF questionnaire. Within and between group comparisons were done for 3 time points, that is less than 12, 13 to 24 and 25 to 36 months following the completion of radiation therapy.
The respective response rates in men who underwent BT/CRT at the 3 time points of less than 12, 13 to 24 and 25 to 36 months was 76%/68%, 54%/46% and 44%/38%, respectively. Mean IIEF erectile function domain scores for these 3 time points after BT/CRT was 26/23, 22/19 and 17/15, respectively. The percent of patients who achieved normalization of the IIEF erectile function domain at the 3 time points in the BT/CRT groups was 60%/50%, 48%/42% and 26%/19%, respectively.
Sildenafil citrate improves erectile function in men in whom erectile dysfunction develops following radiation therapy for prostate cancer. There is a clear time dependence for the response to this therapy with a stepwise decrease in all end points examined serially in a 3-year period.
勃起功能障碍是前列腺癌放射治疗公认的并发症。枸橼酸西地那非是治疗勃起功能障碍的一种知名策略，已发现在包括放疗后勃起功能障碍在内的广泛合并症中均有效。我们确定了枸橼酸西地那非对前列腺癌放疗后勃起功能障碍患者的疗效，并评估了放疗后间隔时间对该治疗成功率的影响。
获取了110例因前列腺癌放疗继发勃起功能障碍患者的基线和随访数据。共有68例患者接受了三维适形外照射放疗（CRT），42例接受了近距离放疗（BT）且未进行雄激素剥夺治疗。根据国际勃起功能指数（IIEF）评估，所有患者在放疗后均被认为存在勃起功能障碍，并给予枸橼酸西地那非治疗。放疗结束至开始服用西地那非的平均时间±标准差为8±4个月。使用IIEF问卷评估对西地那非的反应。在放疗结束后的3个时间点进行组内和组间比较，即少于12个月、13至24个月和25至36个月。
在少于12个月、13至24个月和25至36个月这3个时间点，接受BT/CRT治疗的男性患者的各自反应率分别为76%/68%、54%/46%和44%/38%。BT/CRT后这3个时间点的平均IIEF勃起功能领域评分分别为26/23、22/19和17/15。在BT/CRT组的3个时间点，IIEF勃起功能领域达到正常化的患者百分比分别为60%/50%、48%/42%和26%/19%。
枸橼酸西地那非可改善前列腺癌放疗后出现勃起功能障碍男性的勃起功能。该治疗的反应存在明显的时间依赖性，在3年期间连续检查的所有终点均呈逐步下降趋势。
