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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35471
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Issue is total ED, unresponsive to oral treatment, bimix &

Customer Question

Issue is total ED, unresponsive to oral treatment, bimix & trimix injections. I'm a 58yo that was diagnosed with diffuse Gleason 9 adenocarcinoma of the prostate in Nov-2009. PSA 29. Had IMRT 45 days, then 18 months of Lupron & Casodex. It has been 3.5 months since last Lupron injection. Current PSA <0.1, Testosterone <0.1.. How long does effects of hormonal therapy last?
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 5 years ago.

Did your urologist perform any investigations?
Do you have night time erection?

Dr. Arun
Customer: replied 5 years ago.
Dr.Arun, Thank you for the quick response. Urologist did full battery of lab tests. All normal except for hormones, Current PSA, Testostrone <0.1, LH 0.4, FSH 1.6. No night erections, with 1ml standard trimix injection only partial erection lasting <30 minutes. Urologist counsels 'patience', but we are now about 16 weeks after last once a month Lupron injection.
Expert:  Dr. Arun Phophalia replied 5 years ago.
You are very welcome.

Lupron effects may occasionally last for 6 months or more. So patience is watchword.

For the management of the erectile dysfunctions, one needs to go in step wise fashion, as following;

1) The first step; Oral PDE-5 inhibitors remain the first-line therapy for the treatment of ED in men with no contraindications to their use. The medications are, sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). Efficacy has been demonstrated for general population as well as special populations.


2) The second step;

a) intraurethral suppositories,

b) the vacuum device, and

c) intracavernous injection.

You have tried both of the above options.


3) Third step; Placement of a penile prosthesis is the primary therapeutic option for individuals who have failed or cannot tolerate prior therapies. This is a surgical option. There are two and three-piece inflatable prostheses.

For you this is not the option as you ED is likely to improve.

4) Combination therapies; You may try these, meanwhile, you feel improvement.

a) Sildenafil Plus Intraurethral Prostaglandin E1

b) Oral PDE-5 Inhibitors Plus Intracavernous Injection of Prostaglandin E1

c) Sildenafil Combined with an Oral Alpha-Antagonist

d) Intracavernous Prostaglandin E1 Combined with Oral Alpha-Antagonist

e) Vacuum device and intracavernous injection therapy

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Dr. Arun
Dr. Arun Phophalia and 3 other Health Specialists are ready to help you
Customer: replied 5 years ago.
Dr.Arun, Thank you very much. I will try your combination therapies. Your advice is appreciated..
Expert:  Dr. Arun Phophalia replied 5 years ago.
You are very welcome.

Good luck.