ORIGINAL ARTICLE Psychotherapy and phosphodiesterase-5 inhibitor in early rehabilitation after radical prostatectomy: a prospective randomised controlled trial A. M. E. P. Naccarato 1 , L. O. Reis 2 , U. Ferreira 1 & F. Denardi 1 1 Division of Urologic Oncology, State University of Campinas–UNICAMP, Campinas, Brazil; 2 Pontifical Catholic University of Campinas– PUC-Campinas, Campinas, Brazil Keywords Erectile dysfunction—group psychotherapy— phosphodiesterase-5 inhibitors—prostate cancer—quality of life— radical prostatectomy Correspondence Angela Maria Elizabeth Piccolotto Naccarato, MSc, Rua Emerson Jose Moreira 215, Campinas, S~ao Paulo 13087-045, Brazil. Tel./Fax: +55 19 35217844; E-mail: anganaccarato@terra.com.br Accepted: January 10, 2016 doi: 10.1111/and.12557 Summary The aim of this study was to evaluate the impact of group psychotherapy and the use of a phosphodiesterase-5 inhibitor (PDE-5i) in the early rehabilitation stage of patients with prostate cancer undergoing radical prostatectomy (RP). Fifty-six patients undergoing RP for prostate cancer were randomised into four groups, and 53 completed the protocol: Group 1 – control (n = 11), Group 2 – group psychotherapy (n = 16), Group 3 – lodenafil 80 mg/one tablet per week (n = 12) and Group 4 – group psychotherapy + lodenafil 80 mg/one tablet per week (n = 14). The groups were individually evaluated for erectile function (IIEF-5) and quality of life – QoL (SF-36) weekly, with two meetings held a week apart before the RP and 12 weekly meetings after surgery. The ages ranged from 39 to 76 years, average 61.84. There were no significant medica- tion side effects. Only Group 4 showed improvement in intimacy with a part- ner and satisfaction with their sex life (P = 0.045 and P = 0.013 respectively), and with no significant worsening of the IIEF-5 (P = 0.250) reported. All groups showed worsening in the final result of the role limitations caused by physical problems (P = 0.009) and role limitations caused by emotional prob- lems (P = 0.002) of the SF-36, but Group 4 had a significantly higher score for the role limitations caused by physical problems (P = 0.009) than the other groups. In conclusion, precocious integral treatment involving group psy- chotherapy and PDE-5i before and after RP led to less deterioration of erectile function and other domains related to physical aspects (SF-36), with improve- ment in intimacy with their partner and satisfaction in their sex life, being superior to single treatments. Introduction In Brazil, prostate cancer (PCa) is a leading cause of can- cer-related death in men, second only to nonmelanoma skin cancer (INCA, 2013). Radical prostatectomy (RP) is an effective weapon in this context, although it is associ- ated with significant negative impact on quality of life (QoL), especially regarding sexual function (Rabbani et al., 2001). Sexual function in men is focused on erection and the psychological pain caused by erectile dysfunction (ED) can be more disabling than those related to chronic phys- ical problems, affecting their self-esteem and QoL, and negatively impacting the patients interpersonal interac- tions (Naccarato, 2007). ED is defined as the persistent or recurrent inability to achieve and/or maintain an ade- quate erection for satisfactory sexual activity (NIH, 1993). Interventions in this scenario through psychotherapy, even if potentially effective, are scarce in the literature (Naccarato et al., 2014). This study evaluates the impact of group psychotherapy and the use of a phosphodi- esterase-5 inhibitor (PDE-5i) in erectile function and QoL of patients with PCa who underwent RP in early rehabilitation. Patients and methods The study was approved by a local ethics committee and was a prospective trial randomised by drawing lots concealed in an envelope, involving 56 consecutive © 2016 Blackwell Verlag GmbH 1 Andrologia 2016, xx, 1–5