Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction

Objectives. To ascertain the efficacy of sildenafil citrate (Viagra) in pat ients with erectile dysfunction (ED) either before or after prostate brachy therapy by an open-label, nonrandomized study. Methods. Sixty-two patients who underwent prostate brachytherapy between Ma rch 1995 and July 1998, had ED either before or after brachytherapy, and we re interested in treatment with sildenafil comprised the patient population . Clinical and treatment parameters evaluated for medication efficacy inclu ded patient age at brachytherapy and at medication administration, hyperten sion, diabetes, smoking history, onset of ED, potency status before implant , frequency of intercourse before brachytherapy (if potent), use of neoadju vant hormonal manipulation, use of moderate dose external beam radiation th erapy before implantation, choice of isotope, V100 (the percentage of the p rostate volume receiving at least 100% of the prescribed minimal peripheral dose), and sildenafil dose. Results. Fifty (80.6%) of 62 patients responded favorably to sildenafil. No ne of the treatment parameters predicted medication failure, and among the clinical parameters, only diabetes predicted Failure (3 of 5) and only with borderline statistical validity (P = 0.046). Conclusions. Our results suggest brachytherapy-induced impotence is as amen able to sildenafil treatment as ED from other causes. In addition, our 80.6 % success rate is comparable to reported results for patients who underwent bilateral nerve-sparing radical prostatectomy and significantly better tha n patients who underwent unilateral nerve-sparing or non-nerve-sparing appr oaches. UROLOGY 53: 1112-1116, 1999. (C) 1999, Elsevier Science Inc. All ri ghts reserved.