Stem cells help some men with erectile dysfunction after prostate surgery

Men unable to have an erection after prostate surgery enjoyed normal intercourse thanks to stem cell therapy, scientists are to report on Saturday at a medical conference in London.

In first-phase clinical trials, eight out of 15 continent men suffering from erectile dysfunction had sex six months after the one-time treatment, without recourse to drugs or penile implants.

The positive result showed no signs of flagging during a subsequent year-long monitoring period. “As far as we know, this is the first time that a human study with a 12-month follow up shows that the treatment is lasting and safe,” said Lars Lund, a professor at Odense University hospital in Denmark, who took part in the trials.

“That is much better than taking a pill every time you want to have intercourse,” he said.

The results were promising enough to convince Danish health authorities to authorise so-called phase III “double-blind” randomised trials in which one group of men is given stem cell therapy and another placebos.

Only men recovering from prostate cancer and able to control their bladders will be enrolled in the new experiments, Lund explained.

To perform the procedure, doctors remove fat cells from a patient’s abdomen via liposuction. The cells undergo a brief treatment and emerge as all-purpose stem cells, meaning they can mutate into almost any specialised cell in the body.

“We do not cultivate the cells or change them in any way,” said Lund’s colleague Martha Haahr, head researcher and lead author of a study detailing preliminary results, published last year in EBioMedicine.

The stem cells are then injected with a syringe into the penis, where they spontaneously begin to change in to nerve and muscle cells, as well as the endothelial cells that line blood vessels. Men are under general anaesthesia while all of this happens, and are discharged from hospital the same day.

Prostate surgery is responsible for about 13% of erectile dysfunction cases. Up to 80% of men experience difficulty having sex immediately after an operation, previous research has shown.

Diabetes accounts for 40% of erectile dysfunction cases, and vascular disease another 30%. Men with diabetes would be the next target group for clinical trials, Lund said.

The results reported at the European Association of Urology conference could be an effective “therapeutic option for patients suffering erectile dysfunction from other causes,” Haahr said.

It is estimated that nearly half of men between the ages of 40 and 70 experience erectile dysfunction to some degree.

The global market for drugs treating the disorder is expected to top $ 3.4 billion by 2019.

Failure to perform sexually can also, in some men, result from relationship problems, performance anxiety or repressed homosexuality, Haahr said.

Stem cells help some men with erectile dysfunction after prostate surgery

Does Medicine Assist Avoid Erectile Dysfunction Right after Radiation Treatment For Prostate Cancer?

Day-to-day use of the erectile dysfunction drug tadalafil, compared with placebo, in men undergoing radiation treatment for prostate cancer did not help to protect erectile perform, according to results of a research published in JAMA, April 2.

Erectile dysfunction (ED) frequently develops following treatment for prostate cancer. Up to 40 % of males knowledge ED following radiation treatment, and practically 50 % of all guys use some type of treatment soon after undergoing radiation therapy.

The precise trigger of ED is not obviously defined but it is very likely attributed to penile endothelial dysfunction along with fibrosis and cavernosal hypoxia as most likely mechanisms. The phosphodiestersae-five inhibitors (PDE-5) this kind of as tadalafil used in this research are believed to boost dilatation of the cavernosa and lessen endothelial dysfunction. Whether these medication can be of utility soon after radiation and brachytherapy, which injure both blood vessels and nerves to various degrees was an curiosity of the investigators.

English: Micrograph showing prostatic acinar adenocarcinoma (the most frequent form of prostate cancer) Gleason pattern 4. H&ampE stain. Prostate currettings. See also Image:Gleason 4 and 5 intermed mag.jpg (Photo credit: Wikipedia)

Although tadalafil [Cialis] is used to deal with ED right after prostate cancer treatment method, the authors of this review sought to figure out if there may possibly be a function as a preventive agent. The lead writer, Dr. Thomas M. Pisansky along with his colleagues from the Mayo Clinic, randomly assigned 242 guys with prostate cancer to obtain tadalafil (five mg) or placebo daily for 24 weeks starting up with radiation treatment (either with external radiotherapy [63 percent] or brachytherapy [37 percent]).

The research was carried out at 76 internet sites in the United States and Canada amongst November 2009 and February 2012, with comply with-up by means of March 2013. At 28 to thirty weeks after the start off of radiation therapy, 79 % of the eligible sufferers who acquired tadalafil had preserved erectile perform in contrast with 74 % who acquired placebo, an absolute difference of five percent. A considerable distinction amongst groups was also not observed at one yr (72 percent vs. 71 %). In accordance to the benefits of the study, tadalafil did not lead to enhanced total sexual perform or enhanced satisfaction. In addition, the partners of guys utilizing tadalafil observed no considerable result on sexual satisfaction.

According to Pisansky, “These findings do not assistance the scheduled as soon as-day-to-day use of tadalafil to stop ED in guys undergoing radiotherapy for localized prostate cancer.” The authors suggest that alternative approaches to avoid ED ought to be regarded as, such as change in frequency or intensity of dosing as effectively as option approaches to truly supply the radiation.

One skilled in the management of prostate cancer described limitations of the study.

“The shortcoming of this examine is that it is tough to know if there is any underlying erectile dysfunction in the sufferers to start with, and what’s the nature of their ED.”, in accordance to Dr. David Samadi, Chairman of Urology, and Chief of Robotic Surgical treatment at Lenox Hill Hospital, in New York City.  “Was it really a vascular dilemma, a sensory difficulty or attributed to other brings about.”

“I was in no way a believer that including these variety of prescription drugs before surgery or radiation is going to make a massive variation. If you are definitely perfect, adding some Viagra 2 weeks before surgical procedure will not help you,” Samadi explained.

Soon after surgical treatment, nevertheless, drugs for erectile dysfunction may possibly have a position. This may possibly be observed in particular sorts of surgical approaches for localized prostate cancer.

“The drugs could have a fantastic function right after nerve-sparing surgical treatment throughout penile rehab,” Samadi stated. “As far as radiation is concerned, it takes time for the ED to kick with radiation due to the nature of the ailment itself—but a great deal of instances it is the vascular problem, with less blood getting to the penile tissue and in individuals circumstances these medications will not be successful, ” extra Samadi.

Referring to Pizanky’s study, Samadi commented, “It’s just a single research and it will not show a lot”.  It is an interesting locating, but I’m not shocked.”

In accordance to Samadi, these drugs need to not be regular of care.  As Samadi described, “These prescription drugs are very high-priced, and insurance businesses are not covering this. We will result in a enormous monetary burden on these individuals.”

Timing of Development of ED  

Though many opt for the much less invasive technique and forgo surgical treatment, radiation is nonetheless connected with development of ED—it’s just the timing that defines the distinction.

Does Medicine Assist Avoid Erectile Dysfunction Right after Radiation Treatment For Prostate Cancer?