Efficacy of Medical Interventions for Erectile Dysfunction after Prostate Cancer Treatment: A Systematic Review and...

Area of Science:

• Urology
• Oncology
• Pharmacology

Background:

• Erectile dysfunction (ED) significantly impacts quality of life after prostate cancer treatments like radical prostatectomy (RP) and radiotherapy (RT).
• Current interventions for post-treatment ED lack head-to-head comparative effectiveness data.
• There is a need to evaluate and compare various medical interventions for ED recovery.

Purpose of the Study:

• To systematically review and perform a network meta-analysis (NMA) of medical interventions for ED following RP or RT.
• To compare the effectiveness of different treatments for erectile function recovery.
• To assess the certainty of evidence for ED interventions.

Main Methods:

• Systematic review and random-effects network meta-analysis (NMA) of 41 studies (4,157 participants).
• Searched MEDLINE, Embase, and Scopus databases for eligible studies.
• Assessed risk of bias using Cochrane RoB 2 and ROBINS-I tools; evaluated evidence certainty with GRADE framework.

Main Results:

• For ED after RP, combination therapies showed highest efficacy: tadalafil plus intraureral alprostadil gel (OR 24.8), tadalafil plus vacuum erection device (OR 12.3), and tadalafil plus low-intensity shockwave therapy (OR 8.2).
• For ED after RT, on-demand tadalafil was most effective (OR 8.0).
• Pooled RP data showed significant improvement in International Index of Erectile Function scores (mean difference 4.5) with active interventions; longer duration correlated with better outcomes. Certainty of evidence was low to very low.

Conclusions:

• Combination therapies are most effective for ED recovery post-RP.
• On-demand phosphodiesterase type 5 inhibitors are most efficacious for ED post-RT.
• Findings offer comparative insights but require cautious clinical application and high-quality research.