Psychotherapy-PDE5 Inhibitor Combo Helps Post-RP Erectile Function

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.

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