RESEARCH HIGHLIGHTS Vardenafil Compared with Papaverine in Penile

RESEARCH HIGHLIGHTS

www.nature.com/clinicalpractice/uro high, supporting the current US practice of not vardenafil, which has few adverse effects, GLOSSARY performing a biopsy on the contralateral testis. could be used instead of papaverine. METACHRONOUS Fosså and colleagues evaluated the risk of This study enrolled 24 men with erectile Originating on separate occasions developing a METACHRONOUS contralateral tumor dysfunction aged between 28 and 62 years. SYNCHRONOUS in 29,515 testicular cancer patients reported Penile color Doppler ultrasound evaluation of Originating simultaneously to the National Cancer Institute’s Surveillance, cavernous arterial flow parameters was per- LNCaP Epidemiology and End Results Program formed before and after administration of either A human prostate cancer between 1973 and 2001. They found that men papaverine or vardenafil, with genital and audio- cell line used to study the mechanisms and benefits of with unilateral testicular cancer had a 12.4-fold visual sexual stimulation, at two separate ses- therapeutic interventions increased risk of developing a contralateral sions at least 5 days apart. Peak flow velocity tumor, compared to the general population. had increased significantly by 30 min after oral This risk decreased with time from diagnosis of vardenafil had been taken, reaching a maximum the first tumor, indicating that the increase is not value by 60 min. There was no significant dif- due to radiotherapy. Men with seminoma and ference in mean peak flow velocity between those aged under 30 had a significantly higher papaverine injection after 1, 5, 10 and 20 min, risk than those with non-seminoma tumors and compared with oral vardenafil after 30, 45, 60, those aged over 30. The 10-year overall survival 75 and 90 min. Whereas 12.5% of patients who rate was 93% for patients with metachronous received papaverine suffered from prolonged and 85% for patients with SYNCHRONOUS contra- erection requiring pharmacologic interven- lateral testicular cancer. Interestingly, develop- tion, no such effects were seen with vardenafil. ment of a metachronous contralateral tumor Around 83% of patients reported injection- did not decrease overall survival. related pain, and around 21% reported this The authors point to indirect evidence that to be severe. The most common side effect cisplatin-based chemotherapy might reduce reported for vardenafil was headache (12.5%). the risk of developing a contralateral tumor, The authors conclude that penile color and call for further studies; meanwhile, they Doppler ultrasound with oral vardenafil has reiterate that all men should perform regular promise as a potential noninvasive technique self-examination. Testicular ultrasonography for evaluating erectile dysfunction. or, sometimes, biopsy might be warranted for Carol Lovegrove men at higher risk of developing contralateral Original article Ardicoglu A et al. (2005) Effectiveness tumors, as early detection might allow testis- of vardenafil versus papaverine in penile Doppler sparing surgery. ultrasonography. Urol Int 75: 75–79 Tamsin Osborne

Original article Fosså SD et al. (2005) Risk of contralateral testicular cancer: a population-based study of 29,515 US men. J Natl Cancer Inst 97: 1056–1066 Randomized controlled trial suggests healthy living could slow progression of prostate cancer Vardenafil compared with papaverine in penile Doppler Questions over the wisdom of aggressive ultrasonography treatment for early prostate cancer have led to growing interest in the benefits of diet and exer- Penile color Doppler ultrasound is currently cise; however, randomized, controlled trials are considered the ‘gold standard’ for the evalu- lacking. Ornish and colleagues have examined ation of erectile dysfunction; however, the the effects of intensive lifestyle changes on the technique requires intracavernous injection of progression of early prostate cancer by mea- vasoactive drugs, such as papaverine, which suring serum prostate-specific antigen (PSA), are associated with adverse effects includ- serum-stimulated growth of LNCaP prostate ing prolonged erection and priapism. Anxiety cancer cells, and treatment trends. and pain associated with the injection can also They enrolled 93 men with biopsy-proven interfere with the sensitivity and specificity of prostate cancer of Gleason score <7 and the test. This study aimed to determine whether serum PSA of 4–10 ng/ml, none of whom the oral phosphodiesterase type 5 inhibitor had undergone conventional treatment for

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