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European Association of Urology Congress 2019

PCFA Staff
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Side effects from prostate cancer surgery, their treatment and psychologic implications were high in the agenda of the European Association of Urology Congress 2019 (EAU19 Congress) in Barcelona earlier this year.

Following the update on a new surgical technique for the restoration of sexual function in men post-surgery for prostate cancer, this week we have brought two further articles on the subject that might be of interest to you.


Current treatments for ED include PDE5 inhibitors (such as Viagra), penile implants, and injections, all of which have significant side effects.

At this year’s EAU19 Congress Drs Alberson and Milenkovic stressed that our understanding of the reasons why and how ED happens at the cellular level, has resulted in the development of drug treatments for this debilitating condition. However the detrimental side effects of these drugs and the fact that they are effective only in 6% of the men that take them calls for more research into non-pharmacological ways of treating ED such as the transplant of a man’s own stem cells known as an autologous stem cell transplantation or stem cell therapy.

Over 24 studies conducted in animal studies using stem cells to overcome injury from prostate removal surgery have taught us that in the majority of cases injection of stem cells improves erectile dysfunction.

Stem cells are defined by their ability for self-renewal and differentiation into specialised cell types. In human studies, they are extracted from the abdominal fat of each man after liposuction and are then injected into the spongy tissue of the penis that normally becomes filled with blood during an erection known as corpus cavernosum.

At EAU19 Congress experts asked the question whether it is too early to treat men with ED with stem cell therapy and/or whether it is too risky, the consensus seems to be that it is not risky but it is too early. This is because, so far, only bone marrow cells and stem cells derived from fat cells have been used for injection in clinical trials and that data only on four clinical trials have been published. Of these trials, only two have been conducted in men with ED post-surgery for prostate cancer (see Haahr et al. 2016 and Youi et al.2017) and the other two on treatment of ED in diabetic patients.

In March 2017, the early results of a clinical trial conducted at Odense University Hospital in Denmark1 suggested that stem cell therapy could potentially restore sexual function in men with ED. Researchers found that 8 of the 21 men receiving stem cell therapy were able to engage in spontaneous sexual intercourse within 6 months of the procedure. The results were presented the EUA19 Congress.

What is known as an International Index of Erectile Function (IIEF) questionnaire was used before the stem cell procedure and 6 and 12 months after, to assess the effect of this treatment. A scoring system was used to determine the severity of the condition: an IIEF score of 22-25 was considered normal, 12-16 a mild to moderate ED and 5-7 was considered severe ED. In 8 men the IIEF score rise from 7 to 14 with stem cell therapy. This is an important study indicating treatment for ED without the use of drugs, injections and/or implants.

Yiou and colleagues2 used injection of bone marrow in men with ED after prostate removal and found that the condition improved significantly after 6 months with IIEF scores up to 26 and even determined the dose of cells needed for this effect.  They followed the patients for nearly 62 months and found no serious side effects and no elevated risk for the return of prostate cancer.

It is important to mention here that a prospective, single-blind, parallel-group clinical trial of 123 men suffering from ED whom were given only placebo treatment (no stem cell injections and no other treatment) experienced an increase of 4 points on their IIEF, a spontaneous ED improvement. Men were aware that they were given a placebo. This is important information to know when making a decision to treat men with ED with stem cell therapy, but doctors warned that this should not be used as evidence to make practice recommendations or guidelines.

All evidence to date points to stem cell therapy being safe and this gives hope to a lot of men currently suffering from ED post-surgery for prostate cancer.  However, we will need to wait for the data of phase II trials that are under way so that phase III studies can begin. Recommendations to treat men with ED with stem cell therapy depend on the results of the phase III trials. 



At this year’s Congress, scientists reported that up to 1/5 of men with high neuroticism are significantly more likely to suffer from erectile dysfunction (ED) and incontinence.

Neuroticism is a personality trait. A neurotic person is more likely to be moody and to experience such feelings as anxiety, worry, fear, anger, frustration, guilt, depressed mood, and loneliness than the average person.

The study was conducted at University Hospital in Oslo and involved 982 men who had had their prostates removed. The study used the The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire to measure Quality of Life issues in patients with prostate cancer pre and post-surgery for prostate cancer on  urine leakage, pad use, the perception of the magnitude of the problem, bowel related issues, ability to reach an erection and frequency and firmness, ability to reach an orgasm as well as the overall perception of their sexual function in 761 respondents.

The results showed that 22% of the men scored high for neuroticism, these men showed much worse scores when surveyed on their recovery from radical prostatectomy. Dr. Karol Axcrona said that the results mirror work, which has shown the effect of personality on disease recovery in general, but also stressed that this work needs to be replicated in other studies.

We have previously written a few blogs about erectile disfunction as one of the major side effects of surgery for prostate cancer. This is the first study to show that personality may also be a contributory factor to surgical outcomes related to ED.

Dr. Axcrona, the lead scientist of this study, further showed that the study indicates worse outcomes 3 years after prostate cancer surgery for patients who show a greater tendency towards and that this calls for a personality screening before and after surgery in order to best decide on the course of treatment such as psychological counselling and follow up for these men.

While psychological interventions would highly benefit men with neuroticism tendencies going through surgery, the experts stressed that there is need for more studies in this field. Pre-selection of patients at risk to determine pre and post-counselling would be critical but how issues related to neuroticism in men with prostate cancer in every day practice is not yet clear.

 1. HaahrMK, Jensen CH, Toyserkani NM, Andersen DC, Damkier P, Sørensen JA, Lund L, Sheikh SP. Safety and Potential Effect of a Single Intracavernous Injection of Autologous Adipose-Derived Regen... 2016 Jan 19;5:204-10.

 2. Yiou R, Hamidou L, Birebent B, Bitari D, Le Corvoisier P, Contremoulins I, Rodriguez AM, Augustin D, Roudot-Thoraval F, de la Taille A, Rouard H. Intracavernous Injections of Bone Marrow Mononucleated Cells for Postradical Prostatectomy Erectile ... Eur Urol Focus. 2017 Dec;3(6):643-645. doi: 10.1016/j.euf.2017.06.009.

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