What is Platelet-Rich Plasma (PRP) therapy for erectile dysfunction and how effective is it?

Platelet-Rich Plasma (PRP) Therapy for Erectile Dysfunction: Efficacy and Recommendations

PRP therapy for erectile dysfunction (ED) shows modest efficacy but is not currently recommended for routine clinical use due to limited evidence strength and protocol variations, restricting its use to clinical trials only. 1

What is PRP Therapy for ED?

• PRP is an autologous blood derivative containing concentrated platelets that release growth factors and cytokines from α-granules, promoting tissue healing and regeneration 2
• For ED treatment, PRP is administered via intracavernosal injections, with the goal of promoting angiogenesis, tissue repair, and potentially improving erectile function 3, 4
• The mechanism involves releasing bioactive proteins that promote local angiogenesis, stem cell recruitment, cell migration, proliferation, and differentiation 2

Efficacy of PRP for Erectile Dysfunction

• Meta-analyses show modest improvement in International Index of Erectile Function-Erectile Function (IIEF-EF) scores after PRP treatment:

  • 1 month: 4.05 point increase from baseline 3
  • 3 months: 3.73 point increase from baseline 3
  • 6 months: 3.92 point increase from baseline 3

• Compared to placebo, PRP shows statistically significant but clinically modest benefits:

  • 1 month: 2.99 point improvement 4
  • 3 months: 2.85 point improvement 4
  • 6 months: 3.21 point improvement 4

• A pilot study with vascular ED patients showed IIEF-EF score improvements of 5 points at 1 month, 4 points at 3 months, and 3 points at 6 months, suggesting diminishing effects over time 5

Current Guideline Recommendations

• The European Association of Urology (EAU) 2025 guidelines do not recommend PRP for routine clinical practice, stating: "protocol variations limit evidence strength, restricting the current use of PRP to clinical trials" 1

• PRP therapy lacks standardized treatment protocols, with significant variations in:

  • Preparation methods
  • Concentration of platelets
  • Activation techniques
  • Injection frequency
  • Dosage 2, 4

Comparison to Other ED Treatments

• PRP shows less established efficacy compared to first-line treatments like PDE5 inhibitors 1
• Low-intensity shockwave therapy (LI-SWT) is the only innovative treatment potentially offering a cure for ED with more established evidence 1
• For non-responders to PDE5 inhibitors, the EAU guidelines recommend considering:
  • Vacuum erection devices
  • Intracavernous injections of established vasoactive drugs
  • Low-intensity shockwave therapy
  • Penile prosthesis implantation for end-stage ED 1

Safety Profile

• PRP therapy appears to have a favorable safety profile with minimal reported adverse effects 3, 6
• A pilot study reported no significant side effects during the treatment period 5
• Proper sterile technique is essential during preparation and application 2

Limitations and Future Directions

• High-quality, large-scale randomized controlled trials with standardized protocols are needed before recommending PRP for routine clinical use 4, 6
• The lack of standardization in preparation methods results in variable product content and efficacy 2
• Short-term follow-up in most studies limits understanding of long-term benefits 4

Practical Considerations

• PRP may be considered as an experimental option for patients who:

  • Have failed standard ED treatments
  • Are willing to participate in clinical trials
  • Understand the limited evidence for efficacy 1

• Patients should be informed that PRP therapy is not currently recommended by major urological guidelines for routine clinical practice 1