Sildenafil
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Lack of efficacy: case report An 84-year-old man exhibited lack of effect of sildenafil, indicated for erectile dysfunction and anorgasmia [route not stated]. The man presented with erectile dysfunction and anorgasmia. Treatment with sildenafil 50mg had been ineffective. His past medical history was notable only for atrial fibrillation, treated with warfarin [Coumadin]. Following investigations, he was diagnosed with prostate cancer. Treatment was started with testosterone [Androgel], which led to an improvement in his erection quality and increased libido, energy, and sense of vigor. However, anorgasmia did not resolve. He also received tadalafil as needed. From that point, prostate specific antigen (PSA) increased slightly. At 21 months of presentation, dutasteride was added for lower urinary tract symptoms. However, dutasteride was discontinued 1 month later due to the reluctance in taking additional medications and a lack of perceived benefit. At 24 months, the PSA was 3.8 ng/mL. Prostate exam remained unchanged, without nodularity or other abnormality. At the time of report, he declined follow-up prostate biopsy. Morgentaler A. Two years of testosterone therapy associated with decline in prostate-specific antigen in a man with untreated prostate cancer. Journal of Sexual Medicine 6: 803515100 574-577, No. 2, Feb 2009. Available from: URL: http://doi.org/10.1111/j.1743-6109.2008.01066.x
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