Prostate cancer (PCa) patients undergoing radical prostatectomy may experience a small early loss of penile length after surgery, but this recovers by six months post-operatively, according to new findings. Use of a phosphodiesterase-5 inhibitor (PDE5i) attenuated SFPL loss, with patients who used PDE5i’s regularly experiencing no loss in SFPL, researchers found.

In a study that included 118 men at baseline, a single evaluator measured stretched flaccid penile length (SFPL) before RP and again at two and six months after RP. At two and six months, 76 and 63 men, respectively, were evaluated. At two months post-surgery, patients had a mean 2.4 mm decrease in SFPL, but at six months, they observed no significant difference in SFPL from baseline overall, researchers led by John P. Mulhall, MD, of Memorial Sloan-Kettering Cancer Center in New York, reported online ahead of print in BJU International.

At six months, men who took a daily PDE5i had no SFPL loss, whereas those who did not take a PDE5i consistently had a significant mean 4.4 mm SFPL loss compared with baseline.

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“The present study is among the first to show preservation of SFPL in patients using daily PDE5i as compared with those patients not using regular PDE5i,” the authors wrote.

Dr. Mulhall’s group noted that multiple theories have been proposed for why penile length changes in the post-RP population. One hypothesis, the authors explained, is that “cavernous nerve injury results in sympathetic overdrive, causing smooth muscle contraction and a hypertonic retracted penis during the early phase.”