• linkedin
  • Increase Font
  • Sharebar

    Data cast light on ED/5-ARI connection

    Steven A. Kaplan, MDSteven A. Kaplan, MD

    Dr. Kaplan, a member of the Urology Times Editorial Council, is professor of urology at the Icahn School of Medicine at Mount Sinai, New York.

     

    One of the most troubling barriers to long-term sustainability of medical therapy for BPH is adverse events related to sexual dysfunction. These include erectile dysfunction (ED), ejaculatory dysfunction (EjD), and diminished libido. In particular, 5-alpha-reductase inhibitors (5-ARIs) such as finasteride and dutasteride are the most common class of BPH drugs with these adverse events.

    A study by Nickel et al sheds light on what sexual side effects are actually related to 5-ARIs. In this extensive and robust database, almost 72,000 men age ≥40 years with a diagnosis of prostatism or BPH who received at least one prescription for a 5-ARI, an alpha-blocker, or both over a 20-year period were analyzed. The bottom line: ED risk seems to be at least similar in the 5-ARI group as the group taking an alpha-blocker, whether alone or in combination.

    The authors conclude that in this “real-world” dataset, long-term risk of ED with 5-ARIs has been overstated and that this side effect will usually occur within the first 3 to 4 months.

    There are a number of caveats to consider. Real-life datasets, while viscerally appealing, are also limited by definitions. That is, BPH, prostatism, and impotence have lots of different meanings to patients and/or providers who are coding for them. Also, patients and health care providers often interchange impotence and decreased libido and/or ejaculatory dysfunction.

    Moreover, the study does not address decreases in libido or EjD. These are real and important issues in men who use 5-ARIs. In our published experience, these effects are considerably higher in men using dutasteride than finasteride. In the past, sexual adverse events were always reported in a binary fashion; that is, is it present or not? With grading scales, we now know sexual dysfunction has both a quantitative and qualitative aspect.

    Furthermore, it would be naïve to believe that a drug that reduces prostate volume and serum PSA does not affect seminal volume and therefore ejaculation. Are there long-term consequences and potential irreversibility of long-term use? These are important questions to address, in particular with medications that are used over long time periods.

    Nevertheless, this study does shed some light on the ED/5-ARI connection, and it would appear that we can now more confidently inform our patients of the long-term risks.

    More from Urology Times:

    Prostate MRI-Bx may ID partial gland ablation candidates

    Does shock wave therapy have a future in the treatment of ED?

    Model unable to identify focal therapy candidates


    Subscribe to Urology Times to get monthly news from the leading news source for urologists.

     

    0 Comments

    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Poll