A Systematic Review of the Role of Penile Rehabilitation in Prostate Cancer Patients Receiving Radiotherapy and Androgen Deprivation Therapy

Introduction/Background: Treatment-induced erectile dysfunction (ED) is a common side effect of radiotherapy and androgen deprivation therapy (ADT) that impacts on patient quality of life. Penile rehabilitation interventions including pharmacologic and physical therapies aim to reduce the impact of ED. Despite The National Institute for Health and Care Excellence guidelines recommending access to ED services, penile rehabilitation is not widely discussed or implemented. This systematic review aimed to appraise the evidence base for penile rehabilitation and identify evidence-based recommendations for practice. Methods: A systematic review of the evidence base was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Scopus and Medline (EBSCO) databases were searched for articles relevant to penile rehabilitation interventions for prostate radiotherapy patients. Study quality was graded using the Oxford Levels of Evidence and the Scottish Intercollegiate Guidelines Network. Results: This study identified 19 articles on penile rehabilitation in prostate radiotherapy patients, consisting of eight randomized controlled trials, three systematic reviews, and eight case studies. Findings confirmed the value of early use of phosphodiesterase type 5 inhibitors. Discussion: Despite the range of available physical and pharmaceutical interventions, relevant research focussed solely on the use of phosphodiesterase type 5 inhibitors. Themes from the reviewed articles indicated that timing of intervention was important with early on-going dosage most useful. There was also an identified need for ongoing prophylactic use during ADT. Evidence, in general, was of low quality and based on quantitative data only. Conclusion: Additional research into the wider range of penile rehabilitation interventions is urgently required to ensure patients have access to those therapies that are most appropriate for them. A paradigm shift toward qualitative research in the field of penile rehabilitation for prostate cancer patients treated with radiotherapy and ADT may be of value in future studies.