Table 2.

Current management strategies for ED after RT/ADT from literature analysis

Strategy	No. of publications	Total no of patients	Results	Adverse events	Summary
Conservative management (exercise programme)	1	57	Significant (p > 0.045) difference in sexual activity following 12-week short-term exercise programme 53 Patients undergoing usual care decreased sexual activity while patients in the exercise programme maintained their level of sexual activity 53 Following the intervention, the exercise group had a significantly higher percentage of participants reporting a major interest in sex (exercise > 17.2% vs. control > 0%; p > 0.024) 53	N/A	Short/long term exercise programme improves and maintains EF and improved libido
Psychosexual Counselling and Therapy	3	144	Improved outcomes observed with sexual counselling in men and women with/without partners 52 Sexual functioning is discussed infrequently in routine FUP 51 Despite the presence of partners in nearly half of consultations, involvement of the partner tended to be minimal 51	N/A	Sexual counselling improved ED outcomes for patients and partners Partner involvement in clinical discussions are minimal
Phosphodiesterase type 5 inhibitor (PDE5 I)	15	3532	Efficacious after RT and BT but ADT diminished response to PDE5-I 6,37–39,43–46,49 Better patient satisfaction at 24 months with daily sildenafil 37 Optimal response achieved when PDE5-I initiated 12–24 months after RT 6,41 Significantly better IIEF-5 scores up to 6 months with daily sildenafil after RT, though scores diminished when medications stopped 38 Sexual desire scores remain high up to 24 months after daily sildenafil despite discontinuing treatment 37 Significant increase in mean scores with on demand sildenafil for up to 2 years 43,49 Significantly better IIEF scores with tadalafil after RT over 12 weeks 44,46 Approximately 50% reported successful intercourse with tadalafil (placebo: 9%) (p < 0.0001) over 12 weeks after RT 46,50 The response to PDE5-I treatment is time dependent with a stepwise decrease in all end points examined serially in a 3-year period 43,48 Early use of PDE-5i after BT maintains EF up to 36 months 41,47 No difference between on demand vs. daily use after RT 42 Significantly more functional erections vs. placebo at 24 months despite discontinuing daily sildenafil at 6 months 37 Better compliance observed with once daily dosing 42 Predictors of poor response: older age, longer time after RT, ADT > 4 months duration and RT dose > 85 Gy 43 ADT seems to exert a deleterious effect on PDE5-I response in men undergoing RT 37,47	Mild-to-moderate headaches or facial flushing 37,46,49,50	PDE5-Is are efficacious after RT/BT but their effect can be diminished after ADT Initiating PDE5-I within 1 year of RT correlates with better outcomes Daily therapy associated with better outcomes in the short and long term and on demand therapy associated with better outcomes in the long term Daily dosing associated with better compliance Time-dependent response