Sexual Function in the Prostate Cancer Patient (eBook)

John P Mulhall (Herausgeber)

eBook Download: PDF

2009 | 2009
XX, 268 Seiten
Humana Press (Verlag)
978-1-60327-555-2 (ISBN)

Infos

Sexual dysfunction presents a major challenge to physicians who take on the task of treating men with prostate cancer. While curing the disease and saving a life is paramount, improving technologies and therapies offer skilled surgeons and clinical oncologists the opportunity to eradicate the disease without compromising sexual function. In Sexual Function of the Prostate Cancer Patient, John Mulhall and a panel of internationally recognized experts on prostate cancer and sexual function assess in detail the current state of prostate cancer treatment. The authors offer a broad overview of the pathophysiology and treatment of erectile dysfunction in men with prostate cancer, reviewing the latest findings regarding erection-sparing radiation therapy and sexual function outcomes after laparascopic and robotic prostatectomy. Additional chapters discuss intra-operative maneuvers to minimize post-operative erectile dysfunction and pharmacologic penile preservation and rehabilitation. Timely and authoritative, Sexual Function in the Prostate Cancer Patient is a highly readable guide to preserving post-prostate cancer sexual function that no urologist or radiation and medical oncologist should be without.

Inhalt

Foreword 5
Preface 7
Contents 10
Contributors 12
Color Plates 17
Chapter 1 Sexual Dysfunction After Radical Prostatectomy 18
1.1 Introduction 19
1.2 Erectile Dysfunction 19
2.1 Defining Erectile Function Outcomes After Radical Prostatectomy 20
2.2 Erectile Function Outcomes 22
1.3 Anejaculation 24
1.4 Orgasm Alterations 25
1.5 Peyronies Disease 27
1.6 Penile Length Alterations 28
1.7 Summary 30
Chapter 2 The Impact of Prostate Cancer Diagnosis and Post-treatment Sexual Dysfunction on Quality of Life 34
2.1 Assessing Quality of Life in Prostate Cancer Survivors 34
2.2 The Effect of Prostate Cancer Diagnosis on Generic Quality of Life 36
2.3 The Psychological Effect of a New Prostate Cancer Diagnosis 38
2.4 The Effect of Post-treatment Sexual Dysfunction on Quality of Life 40
2.5 The Psychological Effect of Post-treatment Sexual Dysfunction 44
2.6 Conclusions 45
Chapter 3 Pathophysiology of Erectile Dysfunction Following Radical Prostatectomy 50
3.1 Epidemiology of Prostate Cancer and Erectile Dysfunction 51
3.2 Penile Anatomy and Physiology 52
2.1 Morphology of the Penis 52
2.2 Vascular Anatomy of the Penis 52
2.3 Neural Innervation of the Penis 54
3.3 Molecular Signaling of Erections 54
3.1 NO/NOS 55
3.1.1 Normal Signaling 55
3.1.2 NO/NOS after RRP 56
3.2 Smooth Muscle/Myosin--Actin/Calcium/Rho-Kinase 57
3.3 SHH and the Penis 59
3.4 Supporting Cast/Integration 61
3.4 Long-Term ED 62
4.1 Hypoxia 62
4.2 Ultra-structural End Organ Changes and Long-Term ED 63
3.5 Conclusions 64
Chapter 4 Pathophysiology of Erectile Dysfunction Following Radiation Therapy 71
4.1 Introduction 71
4.2 Normal Physiology 72
4.3 Mechanisms of Injury After Prostate Irradiation 74
3.1 Vasculogenic Mechanisms 74
3.2 Neurogenic Mechanisms 77
3.3 Structural Injury 78
4.4 Conclusion 80
Chapter 5 Evolution of Radical Prostatectomy as It Pertains to Nerve-Sparing 84
5.1 Introduction 84
5.2 Anatomical Considerations 85
5.3 Technique 87
3.1 Initial Steps and Control of Bleeding 87
3.2 Preservation of the Neurovascular Bundle (NVB) 88
5.4 Erectile Function After Nerve-Sparing Radical Prostatectomy 92
5.5 Strategies to Improve Sexual Function after Radical Prostatectomy 94
5.1 Early Use of Intracavernosal Agents 94
5.2 Early Use of Phosphodiesterase-5 Inhibitors 95
5.3 Perioperative Immunophilin Ligand Therapy 95
Chapter 6 Laparoscopic and Robotic-Assisted Radical Prostatectomy: Sexual Function Outcome 97
6.1 Introduction 97
6.2 Heterogeneity of Results 98
6.3 Sexual Function Outcome 98
Chapter 7 Potency-Sparing Radiation: Myth or Reality? 104
7.1 Introduction 105
7.2 Critical Endpoints 105
7.3 Post-radiation Effects on Sexual Function Timing and Targets 108
3.1 Biology, Timing, and Targets 108
3.2 Radiation Reactions 109
3.3 Clinical Syndromes 111
7.4 Potential Target Definition 111
4.1 Prostate Apex Definition 112
4.2 Definition of Critical Erectile Structures (CES) 113
4.3 Radiation Treatment Planning 116
7.5 Potency-Sparing Radiotherapy Preliminary Results 116
7.6 Summary 118
Chapter 8 Neuromodulatory Drugs for the Radical Prostatectomy Patient 123
8.1 Introduction 124
8.2 Pathogenesis of Acute, Traumatic Penile Neuropathy 125
2.1 Peripheral Nerve Degeneration and Regeneration 125
2.2 Cavernous Nerve Injury 127
8.3 Therapeutic Penile Neurogenesis 127
3.1 Preclinical Investigation 128
3.2 Clinical Trials 131
8.4 New Frontiers in Molecular Neurobiology 132
4.1 Signal Transduction Mechanisms 133
8.5 Special Considerations 134
8.6 Conclusion 135
Chapter 9 Nerve Grafting at Radical Retropubic Prostatectomy: Rationale, Technique, and Results 141
9.1 Introduction 141
9.2 Fundamentals 142
9.3 Indications 143
9.4 Surgical Technique 144
9.5 Results 146
9.6 Conclusions 148
Chapter 10 Erectile Function Preservation and Rehabilitation 151
10.1 Introduction 152
10.2 Pathophysiology of Erectile Dysfunction After Radical Prostatectomy 152
2.1 Neural Trauma 153
2.2 Arteriogenic ED 154
2.3 The Concept of Cavernosal Oxygenation 158
2.4 Corporo-venoocclusive Dysfunction 158
2.5 Psychogenic Mechanisms 159
10.3 Penile Rehabilitation of the Erectile Function After Radical Prostatectomy 159
3.1 Data Supporting the Concept of PDE5 Inhibitor Rehabilitation 159
3.2 Endothelial Protection 160
3.3 PDE5 Inhibitor-Induced Neurogenesis 162
10.4 Cavernosal Smooth Muscle Protection 162
4.1 Data Supporting the Concept of Early Postoperative Erection as Rehabilitation 165
10.5 Alternative Rehabilitation Strategies 166
5.1 Intra-urethral Alprostadil Suppositories 166
5.2 Vacuum Erection Devices (VED) 167
10.6 Rehabilitation Regimens 168
10.7 Conclusion 169
Chapter 11 Impact of Androgen Deprivation on Male Sexual Function 175
11.1 Introduction 175
11.2 Penile Erectile Physiology 176
11.3 Preclinical Evidence on the Role of Androgens in Male Sexual Function 177
11.4 Clinical Evidence on the Role of Androgens in Male Sexual Function 181
11.5 Conclusions 183
Chapter 12 The Utility of PDE5 Inhibitors After Radical Prostatectomy 188
12.1 Introduction 189
1.1 Sildenafil 190
1.1.1 Pharmacology and Pharmacokinetics 190
1.1.2 Sildenafil as an On-Demand Treatment Compound: Efficacy in Post-RP Patients 191
1.1.3 Safety of Sildenafil in Post-RP Patients 195
1.1.4 Sildenafil as a Prophylactic Treatment: Efficacy in Post-RP Patients 195
1.2 Tadalafil 198
1.2.1 Pharmacology and Pharmacokinetics 198
1.2.2 Tadalafil as an On-Demand Treatment Option in Post-RP Patients 199
1.2.3 Tadalafil as a Potentially Effective Prophylactic Approach in Post-RP Patients: Evidence from an Animal Model 200
1.2.4 Safety of Tadalafil in Post-RP Patients 200
1.3 Vardenafil 200
1.3.1 Pharmacology and Pharmacokinetics 201
1.3.2 Vardenafil as an On-Demand Treatment Option in Post-RP Patients 201
1.3.3 Safety of Vardenafil in Post-RP Patients 202
12.2 Conclusions 202
Chapter 13 Injectable Therapies After Prostate Cancer Therapy 208
13.1 Introduction 209
13.2 Penile Intracorporal Therapy (ICT) 210
13.3 Mechanism of Action of ICT 212
3.1 Alprostadil 212
3.2 Papaverine 212
3.3 Phentolamine 213
13.4 Complications with ICT 213
4.1 Priapism 213
4.2 Penile Pain 215
4.3 Penile Fibrosis 215
13.5 Benefit of ICT in Penile Rehabilitation 216
13.6 Conclusions 216
Chapter 14 Non-pharmacologic Erectile Dysfunction Treatments After Prostate Cancer Therapy 219
14.1 Introduction 220
14.2 Implantation of Inflatable Penile Prostheses 222
14.3 Outcomes of Penile Prosthesis Placement 226
14.4 Penile Prosthesis Placement Before Radical Prostatectomy 227
14.5 Penile Prosthesis Placement Simultaneously with Radical Prostatectomy 232
14.6 Penile Prosthesis Placement After Radical Prostatectomy 233
14.7 Penile Prosthesis Placement Before Radiation Therapy for Prostate Cancer 234
14.8 Penile Prosthesis Placement After Radiation Therapy 235
14.9 Penile Prosthesis Placement After Hormonal or Other Systemic Therapy for Prostate Cancer 236
14.10 Vacuum Erection Device Therapy 236
14.11 Conclusions 237
Chapter 15 Androgen Supplementation in the Prostate Cancer Patient 242
15.1 Introduction 243
1.1 Testosterone Deficiency and the Prostate Cancer Patient 243
1.2 The Origin of the Prohibition Against TRT in Prostate Cancer Patients 244
15.2 Historical Experience with Testosterone and Prostate Cancer 244
2.1 The Original Report: Huggins 244
2.2 Historical Experience with T Administration in Men with PCa 246
2.3 The Memorial Sloan-Kettering Experience 246
15.3 Modern Evidence Regarding Testosterone and the Risk of PCa 246
3.1 Natural History 246
3.2 Longitudinal Studies of Serum Testosterone and Subsequent Risk of Prostate Cancer 247
3.2.1 Overview 247
3.2.2 Reported Associations Between PCa and T in Longitudinal Studies 247
3.2.3 The Baltimore Longitudinal Aging Study 248
3.3 Clinical TRT Trials 248
3.4 TRT in Men with Prostatic Intraepithelial Neoplasia 248
3.5 Prostate Biopsy in Men with Low Testosterone 249
3.6 Testosterone Flare and PSA 249
15.4 Testosterone Treatment in Men with Prostate Cancer 249
4.1 Rationale 249
4.2 Testosterone Following Radical Prostatectomy 250
4.3 Testosterone Following Other Treatments for PCa 250
15.5 TRT in Men with Untreated or Recurrent PCa 250
15.6 Conclusions 251
Chapter 16 Future Therapies Applicable to Post-radical Pelvic Surgery Patients 254
16.1 Introduction 254
16.2 Pre-operative Optimization of Erectile Function 255
2.1 Pharmacological Preconditioning 256
2.2 Modification of Co-morbidities and Patient Lifestyle 256
16.3 Peri-operative Strategies 257
3.1 Modifying Surgical Approach 257
3.2 Nerve-Replacement Strategies and Optimization of Cavernous Nerve Regrowth 258
3.3 Electrical Stimulation 258
16.4 Post-operative Strategies 259
4.1 Post-operative Penile Rehabilitation 259
4.2 Tissue Engineering 260
4.3 Gene and Stem-Cell Therapies 261
4.4 Next-Generation of Pharmacologic Treatments 262
16.5 Conclusion 263
Index 266
Color Plates 273

Produkt-Details

• Erscheint lt. Verlag: 27.2.2009
• Reihe/Serie: Current Clinical Urology
• Reihe/Serie: Current Clinical Urology
• Zusatzinfo: XX, 268 p. 27 illus., 5 illus. in color.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Urologie
• Schlagworte: anti-androgen therapy • Erectile dysfunction • Prostate Cancer • Prostatectomy • Rehabilitation • sexual function • Surgery
• ISBN-10: 1-60327-555-X / 160327555X
• ISBN-13: 978-1-60327-555-2 / 9781603275552