By Dr. Judson Brandeis, Guest Contributor
Dr. Judson Brandeis is the Director of Clinical Excellence for GAINSWave and an active member of the Sexual Medicine Society of North America. He serves as the Chief of Urology at John Muir Hospital in the Bay Area.
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Once a year, the brightest and most innovative minds in pharmaceutical and device development converge for the annual meeting of the Sexual Medicine Society of North America (SMSNA). These pioneers make up the group that gave us many of the household names in sexual wellness that we’re familiar with today, like Viagra and Cialis, as well as devices like penile implants. So, it should come as no surprise that this year’s convention helped to introduce several technologies and protocols that could potentially lead to much better outcomes for patients, especially those affected by prostate cancer and erectile dysfunction (ED).
Issues with inadequate blood flow to the penis are the cause of ED in 85% of men[i]. Vascular Erectile dysfunction is a disease of the inner lining of arteries, called the endothelium, that restricts blood flow to the penis. The diameter of the small arteries that feed the penis is 1-2 mm. The diameter of the coronary arteries to the heart are 3-4 mm. Because the arteries going to the penis are smaller than the arteries going to the heart, men are more likely to develop ED many years before experiencing a major cardiac event like a heart attack or stroke[ii]. The development of ED is an independent predictor of heart disease.
This is a troubling update that concerns one in six men.
The Prostate Cancer Prevention Trial (PCPT) showed that one out of six men will suffer a cardiac event within seven years of developing ED[iii]. If you have ED, you need to inform your primary care physician or your cardiologist right away. Like many things, having more time to identify, treat and diagnose heart issues leads directly to an improvement in overall outcomes, so vigilance for men, especially middle-aged men, is recommended. Luckily, there are several simple tests your doctor can perform, which can accurately predict cardiovascular risk, including non-contrast cardiac CT scans, which are among the quickest and easiest for physicians to study. These scans typically take less than five minutes to perform, expose the patient to a minuscule amount of radiation, is reasonably affordable, and can create an early warning mechanism to monitor for (and rule out) potentially deadly heart conditions.
ED is a predictor of cardiovascular morbidity and mortality, even after adjusting for common comorbid conditions. As ED represents an early symptom of endothelial dysfunction and atherosclerosis, the Prostate Cancer Prevention Trial has worked to show that the longer someone has ED, the more likely it is that they will have a cardiovascular event. For example, a man who has experienced ED for seven years has potentially increased their risk of a future heart event by 15% over the same amount of time
Another investigation endeavored to determine what kind and how much exercise was enough to improve erectile function. As it turns out, the answer is: not as much as you likely thought. The research team discovered an aerobic “sweet spot” where participants experienced the most significant benefit; Just 40 minutes of supervised aerobic exercise, four times a week at between 40-70% of their HR max, was enough to affect these individuals over six months. An exciting development as it now gives physicians an additional treatment protocol for their patients suffering from ED.
Lastly, there was a great deal of excitement and interest at SMSNA for the first public presentation regarding the Shock Wave Erectile Enhancement Trial or SWEET Study[iv]. For those who may be unfamiliar, GAINSWave® shockwave therapy is an exciting technology that helps men to overcome the effects of erectile dysfunction by triggering angiogenesis, resulting in the growth of new blood vessels in the penis. This nonsurgical treatment has been widely used for the treatment of ED and is currently the only curative treatment available for men that addresses the underlying cause of most men’s ED: reduced blood flow. Although GAINSWave therapy for ED has been available for some time, the treatment and maintenance protocols had never been fully optimized.
This study seeks to address that by enlisting 50 physicians from around North America to sign up patients interested in participating in the SWEET Study. The goal is to collect data on at least 3000 patients from a variety of backgrounds and varying conditions. When you start looking at these kinds of studies, having this number of patients will help to better design optimal therapy protocols for both treatment and long-term maintenance of erectile function.
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[i] “Prostate Cancer Prevention Trial (PCPT): Questions and Answers.” National Cancer Institute, https://www.cancer.gov/types/prostate/research/prostate-cancer-prevention-trial-qa.
[ii] Skerrett, Patrick J. “Erectile Dysfunction Often a Warning Sign of Heart Disease.” Harvard Health Blog, 24 Oct. 2011, https://www.health.harvard.edu/blog/erectile-dysfunction-often-a-warning-sign-of-heart-disease-201110243648.
[iii] “Prostate Cancer Prevention Trial (PCPT): Questions and Answers.” National Cancer Institute, https://www.cancer.gov/types/prostate/research/prostate-cancer-prevention-trial-qa.
[iv] Lu, Scott, and Judson Brandeis. “E-poster Session 3 – Erectile Dysfunction Medical 1.” 20TH ANNUAL FALL SCIENTIFIC MEETING OF SMSNA. 24 Oct. 2019, Nashville, TN.
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This article is sponsored by Gainswave.