L-Arginine Supplementation With or Without Enzyme Inhibitors Treating Erectile Function of Prostate Cancer Survivors

OBJECTIVES:

Primary

- To determine the "best dose" (defined as the dose that shows the greatest improvement in
the erectile function domain of the International Index of Erectile Function [IIEF]
after 8 weeks of therapy) of an L-arginine/Korean ginseng/gingko biloba/damiana-based
supplement (L-arginine) to be used in a subsequent phase III trial in prostate cancer
survivors previously treated with radiotherapy.

Secondary

- Evaluate the toxicity of treatment with L-arginine with or without phosphodiesterase-5
inhibitors.

- Estimate trial accrual, retention, adherence, and variability.

- Assess changes in quality of life (QOL) and sexual function as defined by changes in the
QOL of these patients using the Expanded Prostate Cancer Index Composite, changes in the
other domains of the IIEF (i.e., orgasmic function, sexual desire, intercourse
satisfaction, and overall satisfaction), changes in the Sexual Encounter Profile, and
changes in the percentage of "yes" (positive) responses to either of the two global
efficacy questions.

OUTLINE: Patients are stratified according to age (< 65 years vs ≥ 65 years) and current use
of phosphodiesterase-5 (PDE-5) inhibitors (yes vs no). Patients are randomized to 1 of 3
treatment arms.

- Arm I: Patients receive oral placebo twice daily (total of 6 capsules per day).

- Arm II: Patients receive oral L-arginine and oral placebo twice daily (total of 3
capsules of each per day).

- Arm III: Patients receive oral L-arginine twice daily (total of 6 capsules per day).

In all arms, treatment continues for 8 weeks in the absence of unacceptable toxicity.

Patients may also receive oral sildenafil, tadalafil, or vardenafil (PDE-5 inhibitors).

Patients complete the International Index of Erectile Function and the Expanded Prostate
Cancer Index Composite-26 at baseline and at weeks 4 and 8. Patients also complete the Sexual
Encounter Profile Questionnaire, FACT-P, and the Global Efficacy Questionnaire at weeks 4 and
8.

INCLUSION CRITERIA:

- Male prostate cancer survivor previously treated with radiotherapy and who identifies
himself as concerned with sexual quality of life, including erectile dysfunction.
(seed implants are eligible)

- Had successful sexual activity prior to the commencement of radiotherapy.

- Erectile dysfunction, defined as inability to achieve or maintain an erection
sufficient for satisfactory sexual performance

- Interested in sexual activity and agrees to make at least one sexual intercourse
attempt with a partner every week during the study.

- The usage of PDE-5 inhibitors will be voluntary and will serve as a stratification
factor. Patients taking PDE-5 inhibitors must agree to assume the responsibility for
the cost of PDE-5 inhibitor treatment during the protocol period (8 week period) as
this is not covered in the cost of the trial.

- Patients currently taking PDE-5 inhibitors sildenafil (Viagra®, Pfizer
Pharmaceuticals), tadalafil(Cialis®, Lilly ICOS, LLC), and vardenafil (Levitra®, Bayer
Healthcare / Schering Plough Corp.)must agree to take the medication only as
prescribed by their treating physician.

- Patients taking PDE-5 inhibitors as part of this study must be on a stable dose of
drug for at least one month prior to study entry.

- Must be able to take oral medications.

- > 6 months following completion of all cancer therapy

- No evidence of prostate cancer

- Prior malignancies allowed if no evidence of recurrent disease.

- If previously taken LHRH agonist androgen suppression (e.g, Lupron, Zoladex),
anti-androgen (e.g., Casodex, Eulexin, Nilandron), or estrogenic (e.g.,
diethylstilbestrol) agents, serum testosterone must have returned to the laboratory
normal range

- No planned surgery while on protocol or for 4 weeks following completion of protocol

- Prior cystoscopy is permitted.

- Age > 18

- ECOG performance status 0/1.

- Patients must agree not to start taking an herbal product for erectile dysfunction
during the eight weeks of study intervention.

EXCLUSION CRITERIA:

- No other concurrent erectile dysfunction therapies permitted (i.e. vacuum
pump,cavernosal injections, and other drug therapies). Past use of these and other
therapies permitted if the patient can meet the inclusion criteria above.

- No testosterone supplementation permitted.

- Use of LHRH agonist androgen suppression (e.g, Lupron, Zoladex), anti- androgen (e.g.,
Casodex,Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents within
the last 6 months.

- Prior prostate or lower genitourinary surgery (bladder, penis, urethra,
testicles)including transurethral resection of prostate (TURP). (Prior vasectomy is
allowed)

- Serious cardiovascular disease (unstable angina, supraventricular arrhythmia,
myocardial infarction, symptomatic congestive heart failure, cardiac arrhythmia,
coronary artery bypass surgery within 6 months prior to registration).

- Hypotension (<90/50mm Hg), or uncontrolled hypertension (>170/100 mm Hg)

- Stroke or spinal cord injury within 6 months before registration.

- Patients on Persantine, heparin, Lovenox, warfarin, ginkgo biloba, Plavix, Disalcid,
other blood-thinning medication or with a history of bleeding disorders will be
excluded.(Aspirin < 325mg allowed)

- Current use of cimetidine, ketoconazole, itraconazole, erythromycin, or ritonavir.
Major medical or psychiatric illness which, in the opinion of the investigator, would
prevent completion of treatment or would interfere with follow-up.

- Current or prior use of any organic nitrate within the last 6 months (e.g., use of
nitroglycerin)

- May not receive other investigational agents or devices during 30 days prior to start
of study drug.

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to ArginMax (l-arginine, ginseng, or ginkgo biloba)