Tadalafil Does Not Prevent Erectile Dysfunction After Radiotherapy for Prostate Cancer

TM Pisansky, SL Pugh, RE Greenberg, N Pervez, DR Reed, SA Rosenthal, RB Mowat, A Raben, MK Buyyounouski, LA Kachnic, DW Bruner

Erectile dysfunctionABSTRACT

IMPORTANCE
Tadalafil is used to treat erectile dysfunction after prostate cancer treatment, but its role as a preventive agent is undefined.

OBJECTIVES
To determine primarily whether tadalafil preserved erectile function in men treated with radiotherapy for prostate cancer, and secondarily to determine whether participant- or partner-reported overall sexual function and sexual and marital satisfaction were affected.

DESIGN, SETTING, AND PARTICIPANTS
Stratified, placebo-controlled, double-blind, parallel-group study with 1:1 randomization at 76 community-based and tertiary medical sites in the United States and Canada. Two hundred forty-two participants with intact erectile function scheduled to receive radiotherapy for prostate cancer were recruited between November 2009 and February 2012 with follow-up through March 2013.

INTERVENTIONS
One hundred twenty-one participants were assigned 5mg of tadalafil daily and 121 were assigned placebo for 24 weeks starting with external radiotherapy (63%) or brachytherapy (37%). Participant-reported International Index of Erectile Function response before radiotherapy and at weeks 2 and 4, between weeks 20 and 24, between weeks 28 and30, and 1 year thereafter. Participants and partners could respond also to the Sexual Adjustment Questionnaire and to the Locke Marital Adjustment Test before radiotherapy, between weeks 20 and 24 and weeks 28 and 30, and at 1 year.

MAIN OUTCOMES AND MEASURES
Primary outcome was off-drug spontaneous erectile function 28 to 30 weeks after radiotherapy started. Secondary end points were spontaneous erection at 1 year; overall sexual function and satisfaction; marital adjustment; and partner-reported satisfaction and marital adjustment at 28 to 30 weeks and 1 year, predictors of tadalafil response; and adverse events.

RESULTS
Among 221 evaluable participants, 8 0(79%; 95% CI, 70%-88%) assigned to receive tadalafil retained erectile function between weeks 28 and 30 compared with 61 (74%; 95% CI, 63%-85%) assigned to receive placebo (P = .49); an absolute difference of 5% (95% CI, − 9% to 19%). A significant difference was also not observed at 1 year (72%; 95% CI, 60%-84% vs 71%; 95%CI, 59%-84%; P = .93). Tadalafil was not associated with significantly improved overall sexual function or satisfaction; a significant difference was not observed in any domain subscale. Partners of men assigned tadalafil noted no significant effect on sexual satisfaction, and marital adjustment was not significantly improved in participants or partners.

CONCLUSIONS AND RELEVANCE
Among men undergoing radiotherapy for prostate cancer, daily use of tadalafil compared with placebo did not result in improved erectile function. These findings do not support daily use of tadalafil to prevent erectile dysfunction in these patients.

TM Pisansky, SL Pugh, RE Greenberg, N Pervez, DR Reed, SA Rosenthal, RB Mowat, A Raben, MK Buyyounouski, LA Kachnic, DW Bruner
Tadalafil for Prevention of Erectile Dysfunction After Radiotherapy for Prostate Cancer: The Radiation Therapy Oncology Group [0831] Randomized Clinical Trial
JAMA 2014 Apr 02;[EPub Ahead of Print],