Mulhall Sexual Function in the Prostate Cancer Patient

1. Auflage 2009
ISBN: 978-1-60327-555-2
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 268 Seiten

Reihe: Current Clinical Urology

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.

Autoren/Hrsg.

Mulhall, John P

Inhaltsverzeichnis

1;Foreword;5
2;Preface;7
3;Contents;10
4;Contributors;12
5;Color Plates;17
6;Chapter 1 Sexual Dysfunction After Radical Prostatectomy;18
6.1;1.1 Introduction;19
6.2;1.2 Erectile Dysfunction;19
6.2.1;2.1 Defining Erectile Function Outcomes After Radical Prostatectomy;20
6.2.2;2.2 Erectile Function Outcomes;22
6.3;1.3 Anejaculation;24
6.4;1.4 Orgasm Alterations;25
6.5;1.5 Peyronies Disease;27
6.6;1.6 Penile Length Alterations;28
6.7;1.7 Summary;30
7;Chapter 2 The Impact of Prostate Cancer Diagnosis and Post-treatment Sexual Dysfunction on Quality of Life;34
7.1;2.1 Assessing Quality of Life in Prostate Cancer Survivors;34
7.2;2.2 The Effect of Prostate Cancer Diagnosis on Generic Quality of Life;36
7.3;2.3 The Psychological Effect of a New Prostate Cancer Diagnosis;38
7.4;2.4 The Effect of Post-treatment Sexual Dysfunction on Quality of Life;40
7.5;2.5 The Psychological Effect of Post-treatment Sexual Dysfunction;44
7.6;2.6 Conclusions;45
8;Chapter 3 Pathophysiology of Erectile Dysfunction Following Radical Prostatectomy;50
8.1;3.1 Epidemiology of Prostate Cancer and Erectile Dysfunction;51
8.2;3.2 Penile Anatomy and Physiology;52
8.2.1;2.1 Morphology of the Penis;52
8.2.2;2.2 Vascular Anatomy of the Penis;52
8.2.3;2.3 Neural Innervation of the Penis;54
8.3;3.3 Molecular Signaling of Erections;54
8.3.1;3.1 NO/NOS;55
8.3.1.1;3.1.1 Normal Signaling;55
8.3.1.2;3.1.2 NO/NOS after RRP;56
8.3.2;3.2 Smooth Muscle/Myosin--Actin/Calcium/Rho-Kinase;57
8.3.3;3.3 SHH and the Penis;59
8.3.4;3.4 Supporting Cast/Integration;61
8.4;3.4 Long-Term ED;62
8.4.1;4.1 Hypoxia;62
8.4.2;4.2 Ultra-structural End Organ Changes and Long-Term ED;63
8.5;3.5 Conclusions;64
9;Chapter 4 Pathophysiology of Erectile Dysfunction Following Radiation Therapy;71
9.1;4.1 Introduction;71
9.2;4.2 Normal Physiology;72
9.3;4.3 Mechanisms of Injury After Prostate Irradiation;74
9.3.1;3.1 Vasculogenic Mechanisms;74
9.3.2;3.2 Neurogenic Mechanisms;77
9.3.3;3.3 Structural Injury;78
9.4;4.4 Conclusion;80
10;Chapter 5 Evolution of Radical Prostatectomy as It Pertains to Nerve-Sparing;84
10.1;5.1 Introduction;84
10.2;5.2 Anatomical Considerations;85
10.3;5.3 Technique;87
10.3.1;3.1 Initial Steps and Control of Bleeding;87
10.3.2;3.2 Preservation of the Neurovascular Bundle (NVB);88
10.4;5.4 Erectile Function After Nerve-Sparing Radical Prostatectomy;92
10.5;5.5 Strategies to Improve Sexual Function after Radical Prostatectomy;94
10.5.1;5.1 Early Use of Intracavernosal Agents;94
10.5.2;5.2 Early Use of Phosphodiesterase-5 Inhibitors;95
10.5.3;5.3 Perioperative Immunophilin Ligand Therapy;95
11;Chapter 6 Laparoscopic and Robotic-Assisted Radical Prostatectomy: Sexual Function Outcome;97
11.1;6.1 Introduction;97
11.2;6.2 Heterogeneity of Results;98
11.3;6.3 Sexual Function Outcome;98
12;Chapter 7 Potency-Sparing Radiation: Myth or Reality?;104
12.1;7.1 Introduction;105
12.2;7.2 Critical Endpoints;105
12.3;7.3 Post-radiation Effects on Sexual Function Timing and Targets;108
12.3.1;3.1 Biology, Timing, and Targets;108
12.3.2;3.2 Radiation Reactions;109
12.3.3;3.3 Clinical Syndromes;111
12.4;7.4 Potential Target Definition;111
12.4.1;4.1 Prostate Apex Definition;112
12.4.2;4.2 Definition of Critical Erectile Structures (CES);113
12.4.3;4.3 Radiation Treatment Planning;116
12.5;7.5 Potency-Sparing Radiotherapy Preliminary Results;116
12.6;7.6 Summary;118
13;Chapter 8 Neuromodulatory Drugs for the Radical Prostatectomy Patient;123
13.1;8.1 Introduction;124
13.2;8.2 Pathogenesis of Acute, Traumatic Penile Neuropathy;125
13.2.1;2.1 Peripheral Nerve Degeneration and Regeneration;125
13.2.2;2.2 Cavernous Nerve Injury;127
13.3;8.3 Therapeutic Penile Neurogenesis;127
13.3.1;3.1 Preclinical Investigation;128
13.3.2;3.2 Clinical Trials;131
13.4;8.4 New Frontiers in Molecular Neurobiology;132
13.4.1;4.1 Signal Transduction Mechanisms;133
13.5;8.5 Special Considerations;134
13.6;8.6 Conclusion;135
14;Chapter 9 Nerve Grafting at Radical Retropubic Prostatectomy: Rationale, Technique, and Results;141
14.1;9.1 Introduction;141
14.2;9.2 Fundamentals;142
14.3;9.3 Indications;143
14.4;9.4 Surgical Technique;144
14.5;9.5 Results;146
14.6;9.6 Conclusions;148
15;Chapter 10 Erectile Function Preservation and Rehabilitation;151
15.1;10.1 Introduction;152
15.2;10.2 Pathophysiology of Erectile Dysfunction After Radical Prostatectomy;152
15.2.1;2.1 Neural Trauma;153
15.2.2;2.2 Arteriogenic ED;154
15.2.3;2.3 The Concept of Cavernosal Oxygenation;158
15.2.4;2.4 Corporo-venoocclusive Dysfunction;158
15.2.5;2.5 Psychogenic Mechanisms;159
15.3;10.3 Penile Rehabilitation of the Erectile Function After Radical Prostatectomy;159
15.3.1;3.1 Data Supporting the Concept of PDE5 Inhibitor Rehabilitation;159
15.3.2;3.2 Endothelial Protection;160
15.3.3;3.3 PDE5 Inhibitor-Induced Neurogenesis;162
15.4;10.4 Cavernosal Smooth Muscle Protection;162
15.4.1;4.1 Data Supporting the Concept of Early Postoperative Erection as Rehabilitation;165
15.5;10.5 Alternative Rehabilitation Strategies;166
15.5.1;5.1 Intra-urethral Alprostadil Suppositories;166
15.5.2;5.2 Vacuum Erection Devices (VED);167
15.6;10.6 Rehabilitation Regimens;168
15.7;10.7 Conclusion;169
16;Chapter 11 Impact of Androgen Deprivation on Male Sexual Function;175
16.1;11.1 Introduction;175
16.2;11.2 Penile Erectile Physiology;176
16.3;11.3 Preclinical Evidence on the Role of Androgens in Male Sexual Function;177
16.4;11.4 Clinical Evidence on the Role of Androgens in Male Sexual Function;181
16.5;11.5 Conclusions;183
17;Chapter 12 The Utility of PDE5 Inhibitors After Radical Prostatectomy;188
17.1;12.1 Introduction;189
17.1.1;1.1 Sildenafil;190
17.1.1.1;1.1.1 Pharmacology and Pharmacokinetics;190
17.1.1.2;1.1.2 Sildenafil as an On-Demand Treatment Compound: Efficacy in Post-RP Patients;191
17.1.1.3;1.1.3 Safety of Sildenafil in Post-RP Patients;195
17.1.1.4;1.1.4 Sildenafil as a Prophylactic Treatment: Efficacy in Post-RP Patients;195
17.1.2;1.2 Tadalafil;198
17.1.2.1;1.2.1 Pharmacology and Pharmacokinetics;198
17.1.2.2;1.2.2 Tadalafil as an On-Demand Treatment Option in Post-RP Patients;199
17.1.2.3;1.2.3 Tadalafil as a Potentially Effective Prophylactic Approach in Post-RP Patients: Evidence from an Animal Model;200
17.1.2.4;1.2.4 Safety of Tadalafil in Post-RP Patients;200
17.1.3;1.3 Vardenafil;200
17.1.3.1;1.3.1 Pharmacology and Pharmacokinetics;201
17.1.3.2;1.3.2 Vardenafil as an On-Demand Treatment Option in Post-RP Patients;201
17.1.3.3;1.3.3 Safety of Vardenafil in Post-RP Patients;202
17.2;12.2 Conclusions;202
18;Chapter 13 Injectable Therapies After Prostate Cancer Therapy;208
18.1;13.1 Introduction;209
18.2;13.2 Penile Intracorporal Therapy (ICT);210
18.3;13.3 Mechanism of Action of ICT;212
18.3.1;3.1 Alprostadil;212
18.3.2;3.2 Papaverine;212
18.3.3;3.3 Phentolamine;213
18.4;13.4 Complications with ICT;213
18.4.1;4.1 Priapism;213
18.4.2;4.2 Penile Pain;215
18.4.3;4.3 Penile Fibrosis;215
18.5;13.5 Benefit of ICT in Penile Rehabilitation;216
18.6;13.6 Conclusions;216
19;Chapter 14 Non-pharmacologic Erectile Dysfunction Treatments After Prostate Cancer Therapy;219
19.1;14.1 Introduction;220
19.2;14.2 Implantation of Inflatable Penile Prostheses;222
19.3;14.3 Outcomes of Penile Prosthesis Placement;226
19.4;14.4 Penile Prosthesis Placement Before Radical Prostatectomy;227
19.5;14.5 Penile Prosthesis Placement Simultaneously with Radical Prostatectomy;232
19.6;14.6 Penile Prosthesis Placement After Radical Prostatectomy;233
19.7;14.7 Penile Prosthesis Placement Before Radiation Therapy for Prostate Cancer;234
19.8;14.8 Penile Prosthesis Placement After Radiation Therapy;235
19.9;14.9 Penile Prosthesis Placement After Hormonal or Other Systemic Therapy for Prostate Cancer;236
19.10;14.10 Vacuum Erection Device Therapy;236
19.11;14.11 Conclusions;237
20;Chapter 15 Androgen Supplementation in the Prostate Cancer Patient;242
20.1;15.1 Introduction;243
20.1.1;1.1 Testosterone Deficiency and the Prostate Cancer Patient;243
20.1.2;1.2 The Origin of the Prohibition Against TRT in Prostate Cancer Patients;244
20.2;15.2 Historical Experience with Testosterone and Prostate Cancer;244
20.2.1;2.1 The Original Report: Huggins;244
20.2.2;2.2 Historical Experience with T Administration in Men with PCa;246
20.2.3;2.3 The Memorial Sloan-Kettering Experience;246
20.3;15.3 Modern Evidence Regarding Testosterone and the Risk of PCa;246
20.3.1;3.1 Natural History;246
20.3.2;3.2 Longitudinal Studies of Serum Testosterone and Subsequent Risk of Prostate Cancer;247
20.3.2.1;3.2.1 Overview;247
20.3.2.2;3.2.2 Reported Associations Between PCa and T in Longitudinal Studies;247
20.3.2.3;3.2.3 The Baltimore Longitudinal Aging Study;248
20.3.3;3.3 Clinical TRT Trials;248
20.3.4;3.4 TRT in Men with Prostatic Intraepithelial Neoplasia;248
20.3.5;3.5 Prostate Biopsy in Men with Low Testosterone;249
20.3.6;3.6 Testosterone Flare and PSA;249
20.4;15.4 Testosterone Treatment in Men with Prostate Cancer;249
20.4.1;4.1 Rationale;249
20.4.2;4.2 Testosterone Following Radical Prostatectomy;250
20.4.3;4.3 Testosterone Following Other Treatments for PCa;250
20.5;15.5 TRT in Men with Untreated or Recurrent PCa;250
20.6;15.6 Conclusions;251
21;Chapter 16 Future Therapies Applicable to Post-radical Pelvic Surgery Patients;254
21.1;16.1 Introduction;254
21.2;16.2 Pre-operative Optimization of Erectile Function;255
21.2.1;2.1 Pharmacological Preconditioning;256
21.2.2;2.2 Modification of Co-morbidities and Patient Lifestyle;256
21.3;16.3 Peri-operative Strategies;257
21.3.1;3.1 Modifying Surgical Approach;257
21.3.2;3.2 Nerve-Replacement Strategies and Optimization of Cavernous Nerve Regrowth;258
21.3.3;3.3 Electrical Stimulation;258
21.4;16.4 Post-operative Strategies;259
21.4.1;4.1 Post-operative Penile Rehabilitation;259
21.4.2;4.2 Tissue Engineering;260
21.4.3;4.3 Gene and Stem-Cell Therapies;261
21.4.4;4.4 Next-Generation of Pharmacologic Treatments;262
21.5;16.5 Conclusion;263
22;Index;266
23;Color Plates;273