Among potent men post radical prostatectomy, does the need for phosphodiesterase inhibitors have an impact on sexual bother scores?

OBJECTIVE To determine whether the current definition of potency, inclusive of phosphodiesterase inhibitor (PDEi) use, is valid with respect to sexual bother (SB). This will be assessed by characterizing the effect of PDEi use on SB scores in men who are potent post radical prostatectomy. PATIENTS AND METHODS The study population consisted of patients who were potent both before and after radical prostatectomy, with at least 2 years of follow-up. Disease-specific quality of life data were evaluated by the University of California, Los Angeles, Prostate Cancer Index (PCI) survey. The relationships between changes in sexual function (SF) and SB and use of PDEi over time were evaluated by mixed model analysis controlling for age, clinical risk group, marital status, and time of PCI assessment. RESULTS Of the 246 patients who met the study criteria, 39% reported PDEi use at some point after treatment. PDEi use was not associated with improved SF (P = 0.81). Furthermore, PDEi use was not associated with a change in SB (P = 0.36). Both SF and SB were significantly associated with time of assessment and age, and SF and SB each improved over time. In addition, SB was significantly associated with marital status. CONCLUSION In this analysis, there was no difference in SF scores between men who were potent with or without the use of PDEi. Furthermore, there was no difference in SB scores between men who were potent with or without the use of PDEi. This suggests that the current, inclusive, definition of potency is valid with respect to SB. Keywords: radical prostatectomy, phosphodiesterase inhibitors, sexual bother, CaPSURE INTRODUCTION For men with localized prostate cancer, radical prostatectomy achieves excellent cancer control [1,2]. However, surgery is known to impact sexual function (SF) and sexual bother (SB) [3–6]. The use of phosphodiesterase inhibitors (PDEi) improves SF – specifically erectile function – in patients after surgery for prostate cancer [7,8]. Potency following surgery is most commonly defined as having erections sufficient for intercourse with or without the use of PDEi [9]. However, this definition – inclusive of medication use – does not consider the extent to which men who are potent after surgery with the use of PDEi may be bothered by having to take a medication. Previous studies have suggested a complex relationship between SF and SB, with findings of inconsistent correlation between the two domains [10–12]. For example, a recent study showed that even men with good erectile function post surgery were troubled by their broader sexual outcomes, resulting in worsening SB and quality of life [11]. Therefore, it may not be sufficient to assume patients with good erections post radical prostatectomy have no SB. More than half of patients typically use PDEi to improve their SF post surgery [13–15]. However, no study has assessed whether the use of PDEi in potent men affects SB. Without knowing the impact of PDEi use on SB in potent men, we cannot assume that the current definition of potency, inclusive of PDEi use, is valid with respect to SB. Therefore, this study aimed to characterize the effect of PDEi use on SF and SB scores in men who were potent before and following prostatectomy in a large national prostate cancer registry.