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Pharmacotherapy for Erectile Dysfunction After Treatment for Prostate Cancer
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Pharmacotherapy for Erectile Dysfunction After Treatment for Prostate Cancer
Michaella M. Prasad, M.D.1, Nathanael Hevelone, M.P.H2, Craig C. Earle, M.D., M.P.H.2, Martin G. Sanda, M.D.2, Sandip M. Prasad, M.D., M.Phil1, Jim C. Hu, M.D.3.
1Harvard Longwood Program in Urology, Boston, MA, USA, 2Dana-Farber Cancer Institute, Boston, MA, USA, 3Brigham and Women's Hospital, Boston, MA, USA.
Background: We analyzed administrative data from a national sample of men with Medicare and private insurance for the utilization rates of pharmacotherapy for erectile dysfunction (ED) before and after radical prostatectomy (RP).
Methods: We used the MarketScan Medstat Database to identify 4,505 men who underwent RP during 2003-05. We reviewed the National Drug Classification codes for phosphodiesterase inhibitors (5PDEI), intracavernosal injectable and alprostadil suppository therapies for utilization rates at baseline (up to 3 months pre-RP) and up to 18 months following RP. We assessed the incidence and prevalence of pharmacotherapies by surgical approach. The Mantel-Haenszel Chi-Square test was used to assess change over time.
Results: The study population was distributed between surgical approaches in the following manner: 396 laparoscopic (LRP), 238 perineal (PRP), 3,797 retropubic (RRP), and 74 LRP conversions to RRP. Mean age did not differ significantly by surgical approach (p>0.05). Use of 5PDEI exceeded injectable and suppository therapies. While there was similar utilization of 5PDEI and little use of injectable and suppository therapies prior to RP (p=0.41), the utilization increased significantly in the 6, 12 and 18 month follow-up intervals with the greatest usage in the LRP group (p<0.0001; Figure 1).
Conclusions: Men undergoing RP are likely to employ pharmacotherapy for ED in the immediate postoperative period. This may be impacted by the rising interest in immediate post-RP potency rehabilitation with pharmacotherapies. Men undergoing LRP were more likely to use pharmacotherapy for ED. While the efficacy of the early use of pharmacotherapy for ultimate recovery of sexual function remains unclear, it contributes significantly to indirect surgical costs.
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