For prostate cancer (PCa) patients undergoing radical prostatectomy (RP), adding group psychotherapy to treatment with a phosphodiesterase-5 (PDE-5) inhibitor may lead to lesser declines in erectile function during early rehabilitation, a Brazilian study finds.
Angela Naccarato, MSc, of State University of Campinas-UNICAMP in Brazil, and colleagues randomly assigned 53 patients (aged 39–76 years) undergoing RP (with and without preservation of neurovascular bundles) to 4 groups: lodenafil only (80 mg per week), group psychotherapy only, group psychotherapy with lodenafil, or control. The goal of psychotherapy is to “allow the patient greater pleasure and satisfaction, regardless of the quality of erection,” the investigators stated. The same psychologist administered all group psychotherapy sessions. The study commenced before RP and lasted for 12 weeks afterward.
Each week, the men evaluated their erectile function using the International Index of Erectile Function (IIEF-5). About half of patients reported mild erectile dysfunction before RP (average score 21). The men also assessed their quality of life using the Short-Form Health Survey Questionnaire (SF-36), which gauges multiple areas, including: physical functioning, physical role functioning, pain, health perceptions, energy/vitality, social functioning, emotional role functioning, and mental health.
The combination of group psychotherapy and PDE-5 inhibitor appeared superior to either intervention alone, according to results published in Andrologia. Only men receiving the combination reported improvement in measures of intimacy with a partner and satisfaction with their sex life, along with no significant worsening of their erectile function. The investigators found no associations between age or nerve sparing technique and erectile function.
All patients experienced role limitations in daily activities caused by physical and emotional problems following RP. However, the combination therapy group had higher scores on physical role functioning. Patients taking medication had no significant side effects.
Intervening early in RP likely is important. According to Naccarato and colleagues, “early treatment benefits the sexuality of patients in the short term and may have a positive effect on long-term psychological factors.”
The investigators acknowledged study limitations such as the small number of patients and assessment of just 1 type of PDE-5 inhibitor. As few studies have examined psychosocial interventions, they encouraged future research on a variety of therapies to determine optimal rehabilitation treatment after RP.
Men who regularly consume foods rich in flavonoids, such as fruit, vegetables, tea, and wine, may have a lower risk of erectile dysfunction (ED), a new study finds.
In particular, anthocyanins (found in blueberries, cherries, blackberries, black currants, and radishes), flavanones (found in citrus fruits), and flavones (found in parsley, thyme, celery, and hot peppers) were linked with the greatest benefits for ED prevention.
“Men who regularly consumed foods high in these flavonoids were 10% less likely to suffer erectile dysfunction. In terms of quantities, we're talking just a few portions a week,” stated lead researcher Aedin Cassidy, PhD, professor of nutrition at the University of East Anglia in Norwich, UK, in a press release.
For the joint study with Harvard T.H. Chan School of Public Health, Dr. Cassidy and colleagues examined food-frequency questionnaires completed every 4 years by 25,096 mostly Caucasian men from the Health Professionals Follow-Up Study. In 1998, none of the men had ED, cardiovascular disease, or prostate, bladder, or testicular cancers.
During 10 years of follow-up, ED developed in 35.6% of subjects, according to results published online in the American Journal of Clinical Nutrition. After adjusting for cardiovascular and other factors (such as caffeine and alcohol consumption, body mass index, smoking, and physical activity), the investigators discovered that specific classes of flavonoids were associated with reduced incidence of ED: flavones (-9%), flavanones (-11%), and anthocyanins (-9%).
Men with the highest dietary intake of flavonoids from fruit had a 14% reduction in ED risk. This impact is equivalent to 2 to 5 hours of brisk walking each week.
The investigators performed an analysis by age and discovered a higher intake of these flavonoids was significantly associated with lower ED risk only in men younger than 70 years.
“Our data strengthen the knowledge that a healthy diet, specifically one rich in several flavonoids, together with increased physical activity and maintenance of body weight are important components of health to improve sexual health and CVD risk factor reduction,” Dr. Cassidy's group wrote. “These lifestyle modifications will likely provide benefit regardless of use of current drug therapies, including phosphodiesterase type 5 inhibitors.”
Emerging evidence suggests flavonoids improve endothelial function and blood pressure, which may protect erectile function. Consuming these particular flavonoids as part of a healthy diet also reduces the risk of diabetes and cardiovascular disease.
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