Platelet-rich plasma (PRP) injections are commonly offered to men with erectile dysfunction (ED) by various healthcare professionals at high cost, despite the lack of evidence-based guidelines to support its use or protocols standardized or treatment duration. , according to a new study.

Investigators researched more than 100 clinics in eight populated metropolitan areas in the United States and found that these injections were widely available. The average cost of each injection was over $1,500, and the treatment ranged from one to an indefinite number of injections.

“The take-home message for patients is to approach so-called ‘miracle cures’ with skepticism and realize that many cash-based treatments rely on the art of selling,” said lead author Sriram Eleswarapu, MD, PhD, Assistant Clinical Professor of Urology, University of California, Los Angeles, says | Medscape Cardiology.

“Physicians and other healthcare workers should be aware of the potential for medical harm and financial toxicity. Guideline-compliant, evidence-based care should be prioritized while experimental therapies like PRP are studied in clinical trials. “, did he declare.

The study was published online May 26 in Open JAMA Network.

Consumerization of sexual health

PRP, often referred to as “Priapus shot” or “P-shot,” Eleswarapu said, “has emerged in a variety of medical and cosmetic applications, and some believe PRP injections into the penis could be useful as a regenerative therapy. of ED; however, there is no good data to suggest that PRP actually works for this purpose.”

The American Urological Association (AUA) and the Sexual Medicine Society of North America have released statements that PRP is an investigational treatment that should not be offered for a fee, Eleswarapu points out. In fact, the AAU’s erectile dysfunction guidelines state that men with erectile dysfunction “should undergo a thorough medical evaluation and be offered a variety of proven treatment options, rather than experimental therapies.”

Despite the lack of clinical trial data on PRP for erectile dysfunction, “many providers have started marketing this treatment and charging high fees, with no guarantee that it will work. Unfortunately, men are desperately looking for cures and are willing to pay for therapies with no evidence of benefit, he noted.

To “characterize the landscape” of PRP injection therapy for erectile dysfunction, the researchers used a “secret shopper” approach – a method of market research that involves using a script to learn about products and prices in service industries, they note.

Using an internet search, they identified 109 clinics that offered PRP for ED in eight major metropolitan areas (Atlanta, Boston, Dallas, Houston, Los Angeles, New York, Philadelphia, and Washington, DC) . The researchers contacted the clinics by phone and used a standardized script to request information about prices, protocols, and referrals from clinicians.

Clinics that did not respond were excluded from the study, leaving 90 clinics for which data was available regarding prices and duration of treatment.

Of the providers, only 9% were urologists; 22% were non-physicians and included chiropractors, integrative healthcare providers, naturopaths, nurse practitioners (NPs), and physician assistants (PAs). The most common providers were family physicians (nearly 14%), NPs (nearly 14%), internal medicine practitioners (11%), and “unknown” or “other” providers (12%).

Other provider specialties included anesthesiology, emergency medicine, general surgery, obstetrics/gynecology, oncology, orthopedic surgery, plastic surgery, and physiatry.

Cost ranged from an average price of $1367 (range, $350-$2500) in Los Angeles (n=20 clinics) to $1580 ($1200-$1900) in Washington, DC (n=5 clinics). With the exception of clinics in Los Angeles, the average price in all other regions was ≥$1,500.

The authors point to the “substantial cost”, the lack of a standardized protocol, and the high number of non-physicians as well as physicians with no training in male sexual dysfunction who administered these injections. The investigators say the findings “suggest that off-guideline care was driven by the consumerization of sexual health.”

“Buyer Beware”

Commenting on the study of | Medscape Cardiology, Ryan Terlecki, MD, professor and vice chair of urology, Wake Forest University School of Medicine, said it’s “not surprising for those of us in practice to see what’s going on and that this is motivated by financial benefits”.

Many people in other fields of medicine have found that administering these injections is a “pleasant career change, and they can make a lot of money – often in cash – with little stress and no insurance to deposit.” “, said Terlecki, who was not involved in the study.

“The message for patients is ‘buyer beware’, and for doctors the message is that you can do these injections and you can make a lot of money, but it doesn’t necessarily seem ethical. Even when patients say it worked, maybe it’s a placebo response; but if you want to get rich from a placebo response, is it ethical?”

He noted that there don’t seem to be any safety concerns about PRP injections for ED, since the cells used come from the patient’s own body.

“If you pay close attention to skin prep and how you handle the injections, there doesn’t seem to be a huge risk to anything other than the wallet and maybe trust in the medical community, in the extent that the provider can potentially undermine legitimate attempts to determine whether something is scientifically beneficial.”

No source of funding for the study was provided. Eleswarapu reports receiving personal fees from Metuchen Pharmaceuticals outside of the submitted work. The disclosures of the other authors are listed on the original article. Terlecki receives research funds from the Department of Defense and is a consultant for Boston Scientific; he also receives grants from Boston Scientific and sits on its advisory board.

JAMA Netw Open. Published online May 26, 2022. Full text

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