Vacuum erectile devices for managing erectile dysfunction for those receiving radical prostate radiotherapy and androgen deprivation therapy: a user evaluation

Abstract Introduction: Radiotherapy with androgen deprivation therapy (ADT) is the standard of care for locally advanced prostate cancer but causes erectile dysfunction (ED). Vacuum erectile devices (VED)s are a first-line treatment for ED along with phosphodiesterase-5 inhibitors (PDE5-Is), yet all evidence supporting their use arises from post-surgical ED. This study aimed to assess effectiveness of VEDs for patients with ED resulting from radiotherapy and ADT. Methods: This service evaluation utilised a longitudinal survey method to gather ED scores at baseline, after commencing ADT and after receiving a VED. Patients who were undergoing ADT for prostate cancer either before or alongside radical radiotherapy and who had been referred to receive a VED were invited to participate. Data including how patients used the VED, psychosexual counselling and PDE5-Is were also collected. Thematic analysis was used to identify men’s perceptions of the VEDs. Results: Data from the 15 participants demonstrated statistically significant treatment-related ED but failed to determine impact of VED on this. Qualitative data identified that participants found the VEDs to be unhelpful, too clinical, unappealing, emasculating and frustrating to use. Limited data suggested that VEDs are more effective at treating ED when used in combination with PDE5-Is. Conclusion: Patients in this small sample generally reported dissatisfaction with VED usage. Limited engagement with the study frustrated attempts to draw conclusions regarding the effectiveness of VEDs for radiotherapy patients suffering from ED during ADT and a larger national study should be conducted to establish this. Improvements to the care pathway and access to psychosexual counselling are recommended.