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Keywords:

  • Prostate Cancer;
  • Prostatectomy;
  • Radiation;
  • Rehabilitation;
  • PDE5 Inhibitor;
  • Intracavernosal Injections;
  • Smooth Muscle;
  • Collagen;
  • Oxygenation

ABSTRACT

Introduction.  Prostate cancer is common and is being diagnosed in younger men now compared with two decades ago. Long-term functional outcomes are of significant importance to patient and impact upon the patient decision-making process regarding choice of therapy. Erectile function preservation (rehabilitation) has gained significant traction worldwide despite the absence of definitive evidence in its favor.

Aim.  To define the role of rehabilitation in the prostate cancer patient who has undergone radical prostatectomy (RP).

Methods.  A committee of five experts in the field from three countries was convened, and using a thorough analysis of the literature and the Delphi approach to expert opinion, recommendations were arrived at for clinicians treating men with prostate cancer before and after definitive surgical management.

Results.  Recommendations arrived at included: that clinicians should discuss prevalence rates, the pathophysiology of erectile dysfunction after RP and the predictors of erectile function recovery, that validated instruments should be used using the published cut-offs for normalcy, that rehabilitation be discussed with patients, and that they be informed that significant potential benefits may be associated with rehabilitation.

Conclusions.  The International Consensus of Sexual Medicine (ICSM) 2001 committee on rehabilitation after radical prostatectomy recommended that a discussion occur regarding rehabilitation in all patients undergoing or who have undergone RP. However, the committee recognized the absence of definitive data to date and could not comment on the optimal approach to rehabilitation at this time. Mulhall JP, Bella AJ, Briganti A, McCullough A, and Brock G. Erectile function rehabilitation in the radical prostatectomy patient. J Sex Med 2010;7:1687–1698.