Sexual Function in the Prostate Cancer Patient PDF
Preview Sexual Function in the Prostate Cancer Patient
Sexual Function in the Prostate Cancer Patient Forfurthervolumes: http://www.springer.com/series/7635 Sexual Function in the Prostate Cancer Patient Edited by John P. Mulhall DepartmentofUrology,CornellUniversityWeillMedicalCollege, NewYork Editor JohnP.Mulhall CornellUniversity WeillMedicalCollege Dept.Urology 525East68thSt. NewYorkNY10021 USA [email protected] ISBN978-1-60327-554-5 e-ISBN978-1-60327-555-2 DOI10.1007/978-1-60327-555-2 LibraryofCongressControlNumber:2008942049 (cid:2)c HumanaPress,apartofSpringerScience+BusinessMedia,LLC2009 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(HumanaPress,c/oSpringerScience+BusinessMedia,LLC,233Spring Street,NewYork,NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarly analysis.Useinconnectionwithanyformofinformationstorageandretrieval,electronicadaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyare notidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubject toproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper springer.com Foreword Prostatecancerandsexualfunctionhavebeencloselyintertwinedsincethebegin- ningofthetwentiethcentury,whenradicalperinealprostatectomywasfirstdevel- opedbyHughHamptonYoungasaneffectivetherapyforlocalizedprostatecancer. Itwasimmediatelyrecognizedthattreatmentforprostatecancercameatthecostof erectilefunction.WiththepioneeringdiscoverybyHugginsandHodgesin1941that prostatecancerwouldrespondtocastrationortheadministrationofestrogens,loss ofsexualfunctionbecameindeliblyimpressedinthemindsofbothphysiciansand thepublicasaninevitableconsequenceoftherapyforprostatecancer.Asradiation therapybegantogrowasanattractiveformoftreatmentforprostatecancer,therela- tionshipoftreatmenttosexualdysfunctionbecamemurkier.Manypatientstreated withradiationwereelderly,theirsexualfunctionbeforetreatmentwaspoorlydocu- mented,andhormonetherapywasusedindiscriminatelybeforeandafterradiation, making it difficult to elucidate the effect of radiotherapy on sexual function. The discoverybyWalshandDonkeroftheanatomicallocationofthecavernousnerves intheearly1980sandthedevelopmentbyWalshoftheanatomical,“nerve-sparing” radicalprostatectomybroughtthefieldintomuchsharperfocus.Ratherthansexual function being an unavoidable consequence of effective prostate cancer treatment, it became clear that fine details of surgical technique or the precise way in which the treatment for prostate cancer was delivered had a major impact on the quality ofsexualfunctionaftertreatment.Walshfirstreported,andthenmanyotherscon- firmed,thatitwaspossibleformanymentorecoveradequate,evennormal,erectile functionafterradicalprostatectomyifaskilledprocedurewasdonetoremovethe entireprostateglandwhilepreservingtheneurovascularbundles.Shortlythereafter, riskfactorswereidentifiedthatcouldpredicttheprobabilityofrecovery:age,qual- ity of erectile function before the operation, and quantitative preservation of the neurovascularbundles. The modern era of precise measurement of the effects of prostate cancer treat- mentonsexualfunctionwouldawaitthedevelopmentofmodernoutcomesresearch methods, especially patient-completed quality-of-life questionnaires. These have allowed more reliable and precise measurements of the effect of androgen depri- vationtherapy,radiation,surgery,andothertreatmentsonsexualfunction. With the availability of noninvasive forms of treatment—intracavernous injec- tions, vasodilating agents, and oral phosphodiesterase-5 inhibitors—patients with v vi Foreword erectiledysfunctionafterprostatecancertherapyhadmoreoptions.Withtheready availability of medical information on the Internet and in bookstores, patients’ expectations rose substantially. More and more men became aware of the sexual side effects of each treatment and much more interested in finding a way to treat theircancereffectivelywithoutcompromisingsexualfunction.Asaresult,preser- vationofsexualfunctionhasbecomeanimportantmetricformeasuringthequality ofprostatecancertherapy.Eventhoughthisoutcomehasbeenreportedfartoocasu- ally,toooftenassessedonlybythetreatingsurgeons,thepatientsaswellasreferring physiciansincreasinglydemandtoknowthechancesthatapatientwillrecoversex- ualfunctionaftertherapy. Inthiswonderfulandtimelybook,Dr.JohnMulhallhasbroughttogethermany oftheworld’sexpertsonprostatecancerandsexualfunctiontoassessindetailthe state-of-the-art.Thesechaptersofferabroadoverviewofthepathophysiologyand treatment of sexual dysfunction in men with prostate cancer, and leave the reader withnumerouspearlsofwisdomabouthowsexualdysfunctioncanbeassessedand preventedinthecareofpatientswithprostatecancer. Sexual dysfunction presents a major challenge to physicians who take on the task of treating men with prostate cancer. It is no longer good enough to cure the diseaseorsavethepatient’slife.Inadiseasethatlingersaslongasprostatecancer, evenwhenleftuntreatedortreatedpalliatively,patientsdemandthehighestpossible quality-of-lifecompatiblewiththegreatestlengthoflife.Theyexpectustounder- standexactlyhowourtreatmentalterstheirfunctionandtodoeverythingwecanto minimizethedamage. Wenowknowthatoutcomesofcancertherapy—cancercontrolaswellascom- plicationsandsideeffects—arerelatedtotheskillandexperienceoftheindividual surgeon,thedoseandtechniqueofirradiation,andthequalityofcaredeliverysys- tems.Thebestoutcomerequirestherapydeliveredwiththebestpossibletechnique. For surgery, this means precise, anatomical dissection that allows preservation of theneurovascularbundles.Forradiotherapy,thismeansprecisedeliveryofdosage, eitherthroughbrachytherapyimplantsorintensity-modulatedradiotherapy(IMRT), to deliver maximum tumoricidal doses to the cancer with minimal collateral dam- agetothesurroundingtissue.Forsystemictherapy,thismeansrestraintintheuse ofandrogendeprivationtosituationsinwhichthebenefitclearlyoutweighstheside effects. These are challenges that can be met through greater understanding of the anatomy and physiology of sexual function and through precise measurements of the effects of each therapy, not only on the cancer but also on sexual function. Dr.Mulhallandtheauthorsofthisnewtexthaveprovidedavaluablesourceofinfor- mationthatclearlydefinesthestate-of-the-arttodayandwillundoubtedlystimulate furtherprogressinthefield. PeterT.Scardino,MD Preface Prostate cancer is the most common form of cancer in American men other than skincancer.Itisestimatedthatabout185,000newcasesofprostatecancerwillbe diagnosedin2008intheUSAalone.Almost30,000menwilldieofthediseasein 2008inthiscountry.Itisthesecond-leadingcauseofcancerdeathinmenafterlung cancer.Whileamanhasa15%chanceofbeingdiagnosedwithprostatecancerin hislifetime,only3%dieofthedisease.Thus,inthemodernera,thevastmajorityof menliveforverylongperiodsoftime.Overthecourseofthelast20years,numer- ousdiscoveriesandrefinementsinmanagementhaveoccurredinthisdisease.There havebeenrefinementsinprostatebiopsytechnique,inimagingofprostatecancer, in surgical technique (e.g., the introduction of laparoscopic and robotic prostatec- tomy),inthedeliveryofradiationtherapy,andinthetreatmentofadvanceddisease. Furthermore,theuseofPSAasascreeningtoolhasresultedinafargreaternum- berofmenbeingdiagnosedwithprostatecanceratitsearlieststages.Thishasalso translated into younger men being diagnosed with prostate cancer. Thus, a man’s long-termsexualfunctionhasbecomeanevenbiggerissuenowgiventhesefactors. With regard to the sexual function consequences of the treatment of prostate cancer, the field has changed dramatically over the course of the last 20 years. Manyofthedevelopmentsinthisareahavebeen“undertheradar”andhavebeen missedbymostclinicians.Increasedunderstandingofthepathophysiologyofpost- prostatectomysexualdysfunctionsandpost-radiationtherapyerectiledysfunction, the controversial concept of penile rehabilitation, neuromodulatory drugs, and the impactofandrogendeprivationtherapyonsexualfunctionarebutafewoftheareas in which information explosion has occurred. The purpose of this book is to give thepracticingclinician,whetheraurologist,radiationtherapist,medicaloncologist, internist, or primary care physician, a comprehensive state-of-the-art overview of sexualfunctionchangesandtheirtreatmentsintheprostatecancerpatient. I am proud to say that I have been joined in this effort by the world’s leading authoritiesinthisarea.Iamindebtedtomychairman,Dr.PeterT.Scardino,forhis masterfulforeword.Dr.Scardinoisasurgeon–scientistwhoneedsnointroduction. HeisChairmanoftheDepartmentofSurgeryatMemorialSloan-KetteringCancer Centerandhasmademajorcontributionsinthetreatmentofandresearchinprostate cancer. vii viii Preface This book opens with a chapter on sexual dysfunctions following prostate can- cer treatment. It would be remiss of us if we concentrated solely on erectile dys- functionasthereareothersexualproblemsthatareprevalent,specifically,orgasm changes, penile length changes, and the development of Peyronie’s disease after radicalprostatectomy.Clinicalexperience tellsusthataman’serectilefunctionin themonthsleadinguptohisprostatecancertreatmentisdifferentthanthatbefore hisdiagnosis.Achapter byDr.David F.Penson andDr.ChristianJ.Nelsonhigh- lightsthis,dealingwiththeimpactofprostatecancerdiagnosisonsexualfunction. Dr.KevinT.McVary,aurologist,andDr.CarolA.Podlasek,ascientist,bothworld authoritiesontheconsequencesofnerveinjuryonerectiletissue,discussthepatho- physiologyoferectilefunctionchangesfollowingradicalprostatectomyusingtheir experiencewiththecavernousnerveinjurymodelasanexample. Dr. Victoria J.Croog and Dr. Michael J. Zelefsky, of the Department of Radia- tion Oncology at Memorial Sloan-Kettering Cancer Center, follow with a chapter of the pathophysiology of erectile dysfunction following radiation therapy. Dr. P. WilliamMcLaughlinandDr.GregoryMerrick,bothradiationoncologists,discuss theintriguingconceptoferection-sparingradiationtherapyandwhetherthisispos- sibleornot.Dr.ArthurL.BurnettIIdiscussestheroleofneuromodulatorydrugsin theradicalprostatectomypatient.Dr.Burnetthascontributedsignificantlytothislit- eraturefromaclinicalandlaboratorystandpoint.Itisexcitingtothinkthat,atsome point in time, we may have drugs that prevent cavernous nerve injury or promote cavernousnerveregenerationatthetimeofsurgeryorevenafterradiationtherapy. Achapteronintraoperativemaneuversdesignedtominimizepostoperativeerec- tile dysfunction is written by Dr. Joseph A. Pettus and Dr. Farhang Rabbani. Dr. Rabbani, one of the world’s authorities on cavernous nerve interposition grafting, gives a comprehensive and critical account of this strategy. Dr. Alexander Mu¨ller and I have contributed a chapter on the controversial topic of penile preservation andrehabilitationandpresenttheanimalandhumandatasupportingthisconceptat thistime.Dr.RicardoMunarrizandDr.AbdulTraish,aurologistandbasicscientist, respectively,fromBostonUniversity,highlighttheimpactandrogendeprivationhas on male sexual function. They present elegant data that outline the severity of the impactthatanagonadalstatehasonerectilefunction. Dr.FrancescoMontorsi(thefoundingfatheroftheconceptofpenilerehabilita- tion)andDr.AndreaSalonia,fromMilan,Italy,discusstheuseofPDE5inhibitors intheradicalprostatectomypatientpopulationandextensivelyreviewtheliterature pertainingtotheuseofthesedrugs.Dr.AndrewMcCullough,fromNewYorkUni- versityMedicalCenter,discussesintracavernosalinjectiontherapy,whileDr.Brian R. Lane and Dr. Drogo K. Montague, from the Cleveland Clinic Foundation, dis- cussnon-pharmacologictherapiesforerectiledysfunction,includingpenileimplant surgery,afterthetreatmentofprostatecancer. The penultimate chapter is written by Dr. Abraham Morgentaler, from Boston, whodiscussesthehighlycontroversialsubjectofandrogensupplementationinthe prostate cancer patient. Dr. Morgentaler, the world’s authority in this area, makes a cogent argument in favor of a rational approach to the use of androgens in the prostatecancerpatient.Thebookfinisheswitha“crystalball”viewforthefutureof Preface ix post-radical pelvic surgery pharmacotherapy. This chapter is written by Drs. Tony Bella and Tom F. Lue, from the University of California, San Francisco, and no oneisinabetterpositiontoaddressthisissuethantheyareDr.Lueistheworld’s authorityonstemcelltherapyforerectiledysfunction. Itismyhopethatyou,asaclinician,willfindthisinformationuseful.Further- more,Ihopethatitwillattheveryleastprovokeyouintothinkingdifferentlyabout theseproblemsinthispopulationandperhapsevenalterhowyoupractice. JohnP.Mulhall,MD Contents Foreward ........................................................ v Preface........................................................... vii Contributors ..................................................... xiii ColorPlates ...................................................... xix Chapter1 SexualDysfunctionAfterRadicalProstatectomy .......... 1 RaananTalandJohnP.Mulhall Chapter2 TheImpactofProstateCancerDiagnosisand Post-treatmentSexualDysfunctiononQualityofLife ...... 17 DavidF.PensonandChristianJ.Nelson Chapter3 PathophysiologyofErectileDysfunctionFollowingRadical Prostatectomy ......................................... 33 JoshuaModder,CarolA.Podlasek,andKevinT.McVary Chapter4 Pathophysiology of Erectile Dysfunction Following RadiationTherapy ..................................... 55 VictoriaJ.CroogandMichaelJ.Zelefsky Chapter5 Evolution of Radical Prostatectomy as It Pertains to Nerve-Sparing ......................................... 69 OferYossepowitchandJamesA.Eastham Chapter6 Laparoscopic and Robotic-Assisted Radical Prostatectomy:SexualFunctionOutcome................. 83 PhillipePaparel,JavierRomeroOtero,BertrandGuillonneau, andKarimTouijer xi xii Contents Chapter7 Potency-SparingRadiation:MythorReality? ............. 91 P.WilliamMcLaughlinandGregoryMerrick Chapter8 NeuromodulatoryDrugsfortheRadicalProstatectomy Patient................................................111 ArthurL.BurnettII Chapter9 NerveGraftingatRadicalRetropubicProstatectomy: Rationale,Technique,andResults........................129 JosephA.PettusandFarhangRabbani Chapter10 Erectile Function Preservation andRehabilitation .....................................139 AlexanderMu¨llerandJohnP.Mulhall Chapter11 ImpactofAndrogenDeprivationonMaleSexual Function ..............................................163 RicardoMunarrizandAbdulTraish Chapter12 TheUtilityofPDE5InhibitorsAfterRadical Prostatectomy .........................................177 AndreaSalonia,AlbertoBriganti,AndreaGallina, andFrancescoMontorsi Chapter13 InjectableTherapiesAfterProstateCancerTherapy.......197 AndrewMcCullough Chapter14 Non-pharmacologicErectileDysfunctionTreatmentsAfter ProstateCancerTherapy ...............................209 BrianR.LaneandDrogoK.Montague Chapter15 AndrogenSupplementationintheProstateCancer Patient................................................233 AbrahamMorgentaler Chapter16 Future Therapies Applicable to Post-radical Pelvic SurgeryPatients .......................................245 AnthonyJ.Bella,WilliamO.Brant,andTomF.Lue Index .............................................................257
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