- Email: [email protected]
Efficacy of Oral Sildenafil in Patients With Erectile Dysfunction After Radiotherapy for Carcinoma of the Prostate
IMAGING
Conclusions: We found the use of transperineal ultrasonography, postimplant CT-based dosimetry, coupled with adjustable dose delivery inherent to remote afterloading technology, to give unparalleled control in performing this complex brachytherapy task. Thus, it may be advantageous in certain clinical situations where the resultant MPD is needed to reliably cover the target volume, such as in patients with carcinomas at base locales, when the possibility of moderate to extensive intraprostatic tumor exists, and in patients with large glands. Early PSA data suggest that it may be effective as a definitive treatment with rates of adverse late tissue effects that are acceptable using current technique and doses described herein. Longer follow-up is needed to ascertain its position among the various treatment regimens for prostate carcinoma.
Editorial Comment: This is the treatment that Andy Grove received. To my knowledge this is the first report of the results in which only 28 patients have been followed as long as 5 years. Because of the short followup there is no meaningful information on cancer control. However, the authors know what percentage of patients achieved a nadir of less than 0.5 ngJml. but they do not report it. They state that no patient has incontinence and that based on early experience with urethral strictures, they modified their technique. It w i l l still be many years before we know the true value of this approach. Patrick C. Walsh, M.D.
Efficacyof Oral Sildenafil in Patients With Erectile Dysfunction After Radiotherapy for Carcinoma of the Prostate M. J. ZELEFSKY,A. B. MCKEE,H. LEE AND S. A. LEIBEL,Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York Urology, 53: 775-778, 1999 Objectives. To determine.the efficacy of sildenafil for patients with erectile dysfunction after radiotherapy for localized prostate cancer. Methods. Fifty patients with erectile dysfunction after radiotherapy were treated with sildenafil. Their median age was 68 years (range 54 to 78). All were treated with a three-dimensional conformal external beam radiotherapy approach, and the median dose prescribed to the planning target volume was 75.6 Gy. Patients were initially given 50 mg of sildenafil and instructed to use the medication on at least three occasions. They were then contacted to ascertain the efficacy of and tolerance to the medication. Results. Significant improvement in the firmness of the erection after sildenafil was reported in 37 patients (74%),2 (4%)had partial improvement, and 11(22%)had no response. Significant improvement in the durability of the erection was reported in 33 patients (66%),3 (6%)had partial improvement, and 14 (28%)reported no improvement. Patients with partial or moderate erectile function before using sildenafil were more likely to benefit from the medication compared with those with absent function. Among 29 patients with erections classified as partial after radiotherapy, 26 (90%) had a significant response to the medication. In contrast, only 11 (52%) of 21 with erections classified as flaccid after radiotherapy had a significant response to the medication (P = 0.007). Conclusions. Sildenafil improved erectile function in greater than two thirds of patients with postradiotherapy impotence. Patients with less severe dysfunction are most likely to benefit from this intervention.
Editorial Comment: Sildenafil improves sexual function in men who are impotent following radiotherapy, especially among those with partial erections. Patrick C. Walsh, M.D.
IMAGING Seminomas ComplicatingUndescended Intraabdominal Testes in Patients With Prior Negative Findings From Surgical Exploration F. H. MILLER, W. S. WHITNEY, S. W. FITZGERALD AND E. I. MILLER, Departments of Radiology, Northwestern Memorial Hospital, Northwestern University Medical Center, Chicago, Illinois, and Hoag Memorial Hospital, Newport Beach, California AJR, 172 425-428, 1999 OBJECTIVE. This paper describes the clinical and imaging characteristics of seminoma complicating intraabdominal testes in three patients who had a history of negative findings from surgical exploration of the inguinal canal and scrotum.
1553
Conclusions: We found the use of transperineal ultrasonography, postimplant CT-based dosimetry, coupled with adjustable dose delivery inherent to remote afterloading technology, to give unparalleled control in performing this complex brachytherapy task. Thus, it may be advantageous in certain clinical situations where the resultant MPD is needed to reliably cover the target volume, such as in patients with carcinomas at base locales, when the possibility of moderate to extensive intraprostatic tumor exists, and in patients with large glands. Early PSA data suggest that it may be effective as a definitive treatment with rates of adverse late tissue effects that are acceptable using current technique and doses described herein. Longer follow-up is needed to ascertain its position among the various treatment regimens for prostate carcinoma.
Editorial Comment: This is the treatment that Andy Grove received. To my knowledge this is the first report of the results in which only 28 patients have been followed as long as 5 years. Because of the short followup there is no meaningful information on cancer control. However, the authors know what percentage of patients achieved a nadir of less than 0.5 ngJml. but they do not report it. They state that no patient has incontinence and that based on early experience with urethral strictures, they modified their technique. It w i l l still be many years before we know the true value of this approach. Patrick C. Walsh, M.D.
Efficacyof Oral Sildenafil in Patients With Erectile Dysfunction After Radiotherapy for Carcinoma of the Prostate M. J. ZELEFSKY,A. B. MCKEE,H. LEE AND S. A. LEIBEL,Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York Urology, 53: 775-778, 1999 Objectives. To determine.the efficacy of sildenafil for patients with erectile dysfunction after radiotherapy for localized prostate cancer. Methods. Fifty patients with erectile dysfunction after radiotherapy were treated with sildenafil. Their median age was 68 years (range 54 to 78). All were treated with a three-dimensional conformal external beam radiotherapy approach, and the median dose prescribed to the planning target volume was 75.6 Gy. Patients were initially given 50 mg of sildenafil and instructed to use the medication on at least three occasions. They were then contacted to ascertain the efficacy of and tolerance to the medication. Results. Significant improvement in the firmness of the erection after sildenafil was reported in 37 patients (74%),2 (4%)had partial improvement, and 11(22%)had no response. Significant improvement in the durability of the erection was reported in 33 patients (66%),3 (6%)had partial improvement, and 14 (28%)reported no improvement. Patients with partial or moderate erectile function before using sildenafil were more likely to benefit from the medication compared with those with absent function. Among 29 patients with erections classified as partial after radiotherapy, 26 (90%) had a significant response to the medication. In contrast, only 11 (52%) of 21 with erections classified as flaccid after radiotherapy had a significant response to the medication (P = 0.007). Conclusions. Sildenafil improved erectile function in greater than two thirds of patients with postradiotherapy impotence. Patients with less severe dysfunction are most likely to benefit from this intervention.
Editorial Comment: Sildenafil improves sexual function in men who are impotent following radiotherapy, especially among those with partial erections. Patrick C. Walsh, M.D.
IMAGING Seminomas ComplicatingUndescended Intraabdominal Testes in Patients With Prior Negative Findings From Surgical Exploration F. H. MILLER, W. S. WHITNEY, S. W. FITZGERALD AND E. I. MILLER, Departments of Radiology, Northwestern Memorial Hospital, Northwestern University Medical Center, Chicago, Illinois, and Hoag Memorial Hospital, Newport Beach, California AJR, 172 425-428, 1999 OBJECTIVE. This paper describes the clinical and imaging characteristics of seminoma complicating intraabdominal testes in three patients who had a history of negative findings from surgical exploration of the inguinal canal and scrotum.
1553