Dear Tom,

First of all, requesting $39 for a single article is disgusting.  I
can't stand "medical profiteering".  I suggest you subscribe to
amedeo.com, an excellent resource I just found.  They provide up-to-
date info to doctors, and they abstract hundreds of journals.

You can get a free weekly email summary of developments about a
particular topic of interest.  For example, on PC they abstract 46
journals, but they will give you info from *some* of them for free.
When I recently needed to find updated info on salvage RT, I looked
through their latest weekly summary of abstracts.  It was laborious,
but fruitful.

Secondly:  What kind of info does your insurance company want?

It reminds me of the story about when Gertrude Stein died.  She was
surrounded by friends and relatives, and somebody said:  "Gertrude,
Gertrude, what is the answer?"  And she replied, "What is the
question"?

There are 2 issues pertaining to whether Viagra and other PDE5-
inhibitors "work".

1) Will it help you get an erection after surgery?

2) Will it help restore your natural erectile function or speed or
restoration of same.

As far as Q #1, if you have a certain amt of nerve function after
surgery, Viagra may well help you function sexually.   As far as Q #2,
there really is no evidence of that, except maybe that Viagra, *in
conjunction with intracavernosal injections*, may do something.
That's what they call "combination therapy".  Also, I do have an
article from the Cleveland Clinic which says Viagra helps to increase
"smooth muscle tissue" in the penis.

There is an onging study at Hopkins re: "Effect of Viagra on return of
EF after RP".  Still in progress.  Contact: Dr. Pavlovich,
410-550-0013.

Also, from nature.com (free). Feb '06. "Early combination therapy:
intracavernosal injections and sildenafil following RP increases
sexual activity and the return of natural erections".  Int'l Journal
of Impotence Research (2006) 18, 446-451.  Nandipati, Raina et al.

The best article on the subject of ED and penile rehab after RRP which
I have referred to here before, is a study by the Cleveland Clinic:
"Erectile Dysfunction Following RRP:  Epidemiology, Pathophysiology
and Pharmacalogical Management".  Same authors as ones cited for above
article.  Available at clevelandclinic.org website in its entirety.
The only thing that may benefit you is this:  "The investigators
concluded that early us of sildenafil (50 mg) following RP appears to
preserve smooth muscle content, and at doses of 100 mg increases the
smooth muscle content.  This article then describes 2 studies which
have found that Viagra may help in "penile rehab", but they are both
described as flawed. The second sounds more promising (use of
vardanafil), but there was no control group used in the study, so its
validity has been questioned.

["Restoring Erectile Function: Proactive Options after RP", 4/1/05,
Wayne, Hellstrom et al. Contemporary Urology."  See the discussion on
"Penile Rehab".  Sorry.  This article emphasizes that injections are
the gold standard for penile rehab.  What I had highlighted was
something about early injections may increase the responsiveness to
Viagra.]

I am losing sleep because I see that in this particular group there is
a lack of knowledge about "penile rehab" after RP, which is closely
related to the issue of "penile shrinkage".  I am going to address
this in a separate post, hopefully.

* But to all men who are or who have undergone RP, if your sexual
function is not restored by 2 mos. you should see an *ED specialist*.
If Viagra is not working for you by then, chances are it won't, at
least for a while. Your best bet, based on available research, is
starting injection therapy ASAP.  The pump is not effective in
restoring natural erectile function, or at least it's efficacy has
been questioned.

You can search this group's archives and find a number of posts by me
on sexual or penile rehab.  Search callalily and "rehab".  Also "Sex
after Surgery". This is a subject I've done a ton of research on.

By medical stds, the article you mention is a bit outdated, I think
(2004).  Of course, the person who would know more about this than
anybody, is Dr. Mulhall at MSK.

I think you are fighting an uphill battle, Tom.  It might just be
easier to order the stuff from India; it's the real thing.

I hate to give men the "dead men don't have sex" line,  but I know
that in my case, since Ted has had his recurrence, sex is at the
bottom of the priority list.  Anatole Broyard, a literary critic for
NY Times, wrote an interesting book about his experience with PC.
Excerpt:

"When I heard that the cancer might affect my sexuality, my "mind
became immediately erect".

But also:

"After my brush with death I feel that just to be alive is a permanent
orgasm".

I have a ton of stuff on ED and RP and hope to use it as the basis of
a Series of articles on penile rehab, penile shrinkage, preventative
measures for averting ED, and treatment of ED.  In any case, I just
posted a major opus on my blog on "Sexy Secrets for Finding an (ED)
doctor".  I might post it here, but it is a big long.

Too tired to proofread this.  All the best.

Leah
prostatecancerblog.net

"As the poets have mournfully sung,
Death takes the innocent young.
The rolling in money,
The screamingly funny,
And those who are very well hung."

I'd be surprised if the managed care managers will read any more
than the abstract, and you'll be lucky if they read that.

I'd also be surprised if proving your point (that your treatment
for PCa caused your ED difficulties) would have any effect on
their decision.  Most people with ED have some physical cause -
whether it be diabetes, cardiac drugs, treatment for PCa, or just
aging, and a good number of those can be helped by Viagra.  But
Viagra is very expensive and the insurance companies believe that
having a better sex life, whatever the cause of the problem, is
not something they are obligated to assist.

In other words, if their denial of assistance with purchasing
Viagra is not based on the fact that you have a physical problem,
then you may be wasting your time appealing.  I expect them to
fight hard on this for fear that a very large number of their
clients might also benefit from Viagra and allowing one in the
door might force them to allow others.

But good luck to you.

If you don't get anywhere, you might try the online Indian
pharmacies, which sell the drug a lot cheaper.

   Alan

...

...

Do you have access to a college library?  They can usually arrange an
interlibrary loan request.  The library that has the article will then fax
a photocopy.  Perhaps some public libraries offer this service, too.  It's
worth asking.  Be ready to supply them with the full bibliographic
reference.  

Another thing you could try is e-mailing the author and asking for a reprint
of the article.  Often, journals will provide these to authors as a
courtesy.  He may refuse, but you never know ...

--charlie