A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment: Evidence for erectile restoration and cavernous nerve regeneration
Eric Chungabc
aAndroUrology Centre, Brisbane, QLD, Australia bUniversity of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia cMacquarie University Hospital, Sydney, NSW, Australia
Objective: The following article explores our evolving understandings of the role of regenerative technology as an effective penile rehabilitation tool in men with erectile dysfunction (ED) in the setting of prostate cancer (PCa) treatment and PCa survivorship. Methods: This narrative clinical review paper summarizes what is currently known about various modalities of regenerative therapy in restoring spontaneous erectile function (EF) in men following PCa treatment with an emphasis on penile rehabilitation strategies. Results: Conventional medical therapy often does not reverse underlying endothelial dysfunction or promote neuro-vasculogenesis to preserve penile health in men with ED. Over the past decade, there has been considerable interest in the role of regenerative therapy to restore endothelial dysfunction and ED without future dependency on medical therapy. Regenerative therapy can be classified into cellular-based (immunomodulators, stem cells, and platelet-rich plasma), biomaterials (nerve graft transfer), and device-related technology (low-intensity shockwave). Although published literature shows early promise in the role of regenerative technology for ED, there is a paucity of high-quality clinical trials in the setting of penile rehabilitation and PCa survivorship to support their use as standard care and be adopted in clinical guidelines. Conclusion: While the use of regenerative technology to restore EF is exciting and highly innovative, considerable limitations remain regarding actual clinical translation and the need for longer-term efficacy and safety data as well as governmental regulation on clinical framework and more robust clinical studies before they can be accepted as standard of care to restore EF in men following PCa treatment.
. [J]. Asian Journal of Urology, 2022, 9(3): 287-293.
Eric Chung. A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment: Evidence for erectile restoration and cavernous nerve regeneration. Asian Journal of Urology, 2022, 9(3): 287-293.
- Neuro-regenerative effects by preventing nerve injury and enhancing functional recovery
- Mulhall et al. [15]; First et al. [16]
- No improvement in EF compared to PDE5i drug
SCT
- Cellular proliferation and multi-differentiation to repair damaged tissues through paracrine, neurogenic, and anti-apoptotic effects; synergistic action with neurotrophic and angiogenic growth factors
- Yiou et al. [25]; Haahr et al. [26]; Haahr et al. [27]; Protogerou et al. [28]
- Short-term data; inconsistent effect on EF to determine the ideal candidate for SCT
Platelet-rich plasma
- Recruitment of stem cells, modulation of inflammatory responses, and stimulation of angiogenesis and neuronal regeneration
- Matz et al. [36]
- Heterogenous study; clinical trial focuses on safety and feasibility rather than EF outcome
Low intensity extracorporeal shockwave therapy
- Induce tissue neovascularization and alteration in tissue apoptosis through release of angiogenic factors
- Frey et al. [42]; Baccaglini et al. [44]
- Small study population; single centre study with short-term data; lack of objective measures with penile color duplex ultrasound
Nerve transfer (neurorrhaphy)
- Somatic-to-autonomic neurorrhaphy to restore neural conduit
- Souza Trindade et al. [51]; Reece et al. [52]
- Retrospective analysis; clinical effect questionable in radiation group and those with ED more than 2 years
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