Erythropoietin misses mark in erectile function recovery after radical prostatectomy

Use of erythropoietin, a promising neurotrophic factor for neurogenic erectile dysfunction based on preclinical and retrospective data, has failed to improve recovery of erectile function in men undergoing radical prostatectomy for prostate cancer compared to placebo, a study has shown.

This phase II, double-blinded, randomized, placebo-controlled trial was conducted from July 2017 to December 2019. The investigators assessed the impact of perioperative erythropoietin on recovery of erectile function and other patient-reported, health-related quality of life outcomes after bilateral nerve-sparing radical prostatectomy (3, 6, 9, and 12 months).

Erythropoietin (20,000 units) or saline placebo was injected subcutaneously the day before, day of, and day after surgery for three total doses. Sixty-three patients were assessed for eligibility, but only 56 (median age 55.5 years) were randomized (29 erythropoietin and 27 placebo; 89.3 percent robotic).

International Index of Erectile Function-Erectile Function Domain (IIEF-EF) scores increased from median 12.5 at 3 months to 24.5 at 12 months. Median 2-week serum haemoglobin was higher for men receiving erythropoietin than those on placebo (14.7 vs 13.6; p=0.02).

No statistically significant difference was noted in IIEF-EF scores at 6 months between erythropoietin and placebo (p=0.50) or at other time points (mixed model regression coefficient, –1.7, 95 percent confidence interval [CI], –6.1 to 2.7; p=0.45). Moreover, an association existed between excellent nerve-sparing rating (10/10) and improved IIEF-EF recovery (+5.2; p=0.022).

During follow-up, other patient-reported, health-related quality of life domains, as well as oncologic outcome and complications, were comparable between the two treatment arms.

“Further research to identify effective adjuncts to improve health-related quality of life for these men is needed,” the investigators said.