A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment: Evidence for erectile restoration and cavernous nerve regeneration

OBJECTIVE: The following article explores our evolving understandings of the role of regenerative technology as an effective penile rehabilitation tool in men with erectile dysfunction (ED) in the setting of prostate cancer (PCa) treatment and PCa survivorship. METHODS: This narrative clinical review paper summarizes what is currently known about various modalities of regenerative therapy in restoring spontaneous erectile function (EF) in men following PCa treatment with an emphasis on penile rehabilitation strategies. RESULTS: Conventional medical therapy often does not reverse underlying endothelial dysfunction or promote neuro-vasculogenesis to preserve penile health in men with ED. Over the past decade, there has been considerable interest in the role of regenerative therapy to restore endothelial dysfunction and ED without future dependency on medical therapy. Regenerative therapy can be classified into cellular-based (immunomodulators, stem cells, and platelet-rich plasma), biomaterials (nerve graft transfer), and device-related technology (low-intensity shockwave). Although published literature shows early promise in the role of regenerative technology for ED, there is a paucity of high-quality clinical trials in the setting of penile rehabilitation and PCa survivorship to support their use as standard care and be adopted in clinical guidelines. CONCLUSION: While the use of regenerative technology to restore EF is exciting and highly innovative, considerable limitations remain regarding actual clinical translation and the need for longer-term efficacy and safety data as well as governmental regulation on clinical framework and more robust clinical studies before they can be accepted as standard of care to restore EF in men following PCa treatment.