Efficacy of Medical Interventions for Erectile Dysfunction after Prostate Cancer Treatment: A Systematic Review and Network Meta-Analysis.
After radical prostatectomy, tadalafil plus intraurethral alprostadil gel showed the highest odds of erectile function recovery versus placebo.
Efficacy of Medical Interventions for Erectile Dysfunction after Prostate Cancer Treatment: A Systematic Review and Network Meta-Analysis.
Despite a wide array of available interventions, their comparative effectiveness remains uncertain in the absence of head-to-head trials.
Erectile dysfunction (erectile dysfunction) is a prevalent and distressing consequence of radical prostatectomy (radical prostatectomy) and radiotherapy (radiotherapy) for prostate cancer, profoundly impacting quality of life.
We conducted a systematic review and network meta-analysis (network meta-analysis) of studies evaluating medical interventions for erectile dysfunction following radical prostatectomy or radiotherapy.
Odds of erectile function recovery were 24.8 times the odds with placebo, with low to very low certainty evidence.
Forty-one studies (n=4,157 participants) met inclusion criteria.
Following radiotherapy, on-demand tadalafil was the most effective intervention (OR 8.0).
Pooled analysis of radical prostatectomy studies showed a significant mean improvement in International Index of Erectile Function scores favouring active interventions over control (mean difference 4.5, 95% CI: 2.4-6.5, I²=62%), with longer intervention duration associated with greater improvement.
Combination therapies appear most effective for erectile dysfunction recovery after radical prostatectomy, while on-demand phosphodiesterase type 5 inhibitors are most efficacious after radiotherapy.
These findings provide novel comparative evidence; however, cautious clinical application and further high-quality research are warranted.