Baseline Prevalence of Erectile Dysfunction in a Prostate Cancer Screening Population

Association Between Erectile Dysfunction and Subsequent Prostate Cancer Development: A Population-Based Cohort Study With Double Concurrent Comparison Groups

Recent studies indicate that erectile dysfunction (ED) and prostate cancer share common potential risk factors such as chronic inflammation, prostatitis, cigarette smoking, obesity, a high animal fat diet, sedentarism, and depression. There is great interest in knowing if ED is associated with prostate cancer. This study aimed to investigate if men afflicted with ED harbor an increased risk of prostate cancer, utilizing two concurrent comparison groups, constructed from the Taiwan NHIRD, with up to 8 years' follow-up. Among men with no preexisting prostate cancer, an ED group of 3,593 men ≥ 40 years of age and two non-ED comparison groups of 14,372 men from the general population, 1:4 matched by age and index date (GENPOP); and 3,594 men with clinical benign prostatic hyperplasia (BPH), matched by similar criteria were assembled. A Cox model was constructed to calculate the adjusted hazard ratio (aHR) after controlling for age, socioeconomic factors, and various medical comorbidities. During the 11,449 person-year follow-up for the ED group, 24 incident prostate cancer developed. During the 44,486 and 11,221 person-year follow-up for the GENPOP and the BPH group, respectively, there were 33 and 25 incidents of prostate cancer. The ED group demonstrated a 2.6-fold greater risk of prostate cancer than that by the GENPOP with an aHR of 2.63 (95% confidence interval [CI] [1.51, 4.59], p < .001). There was no significant difference in risk between ED and BPH group (aHR = 0.83, 95% CI [0.46, 1.48]). This concurrent, double comparison, longitudinal study revealed a positive association between ED and subsequent prostate cancer incidence.

Sexual healing in patients with prostate cancer on hormone therapy

Since prostate cancer becomes more common with age, at least one-third of men have sexual problems at diagnosis. All localized treatments for prostate cancer greatly increase the prevalence of sexual dysfunction, which include loss of desire, erectile dysfunction, and changes in orgasm. Even men on active surveillance have a higher rate of problems than matched peers without prostate cancer. However, men given androgen deprivation therapy (ADT) have the worst rates of sexual dysfunction. Even after 3 to 4 months of ADT, men's desire for sex is decreased and irreversible damage may occur to the erectile tissue in the penis. Erections do not recover in about one-half of men, even if ADT is discontinued. Although intermittent ADT allows some recovery of sexual function, serum testosterone requires 9 to 12 months off ADT to recover. Again, one-half of men have permanent erectile dysfunction. If ADT causes atrophy of the erectile tissue, blood leaks out of the venous system during erection. This syndrome is difficult to treat except with surgery to implant a penile prosthesis. Despite the high rate of sexual problems in men on ADT, a small group stays sexually active and is able to have reliable erections. To improve men's sexual satisfaction on ADT, it may be important to educate them about getting extra mental and physical sexual stimulation, as well as using penile rehabilitation during hormone therapy. Information on reaching orgasm and coping with problems such as dry orgasm, pain with orgasm, and urinary incontinence during sex also should be provided.

A pilot study of potential pre-operative barriers to couples' sexual recovery after radical prostatectomy for prostate cancer

Prostate cancer affects couples' sexual intimacy, but men rarely use recommended proerectile aids. This mixed-methods study aimed to identify couples' preprostatectomy barriers to sexual recovery. Interviews about anticipated sexual recovery were paired with surveys: the Dyadic Assessment Scale, the Protective Buffering Scale, the Expanded Prostate Cancer Index Composite, the Sexual Experience Questionnaire (men), and the Female Sexual Function Index. Potential barriers were derived using Grounded Theory. Quantitative data triangulated qualitative findings. Heterosexual couples (N = 28) participated. Men's average age was 62 years and their partners' average age was 58 years. Preexisting and diagnosis-related barriers included aging-related sexual dysfunction, inadequate sexual problem-solving skills, stressors, worry, avoidance of planning for sexual recovery, and dislike of artificially assisted sex. Participants endorsed moderate/high marital satisfaction (DAS: for men, M = 110.0, SD = 11.4; for partners, M = 114.1, SD = 12.1) and communication (PBS: for men, M = 24.5.2, SD = 6.1; for partners, M = 25.1, SD ± 6.2). Men reported mild erectile dysfunction and incontinence (EPIC sexual function M = 76.6, SD = 21.5, urinary incontinence M = 88.4, SD = 18.2). Men's couple sexual satisfaction was lowest (Sexual Experience Questionnaire: M = 60.1, SD = 26.9). Mean total Female Sexual Function Index was low (M = 21.6, SD = 7.8). Heterosexual couples face prostatectomy-related sexual side-effects having experienced developmental sexual losses. Couples use avoidant strategies to defend against worry about cancer and anticipated prostatectomy-related sexual changes. These potential barriers are modifiable if couples can learn to cope with sexual losses and accept sexual rehabilitation strategies.

The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer

PURPOSE

NCCN Guidelines® recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced.

MATERIALS AND METHODS

During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure.

RESULTS

At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70% were clinical stage cT1 and 93% were Gleason score less than 7. Of biopsies followed by evaluations 40% were the first undergone by the patient and 9% were the fifth to ninth. At the first erectile function evaluation 15% of men were inactive, 8% engage in stimulation and 77% engaged in intercourse. Sexual activity level changed in greater than 20% of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores.

CONCLUSIONS

Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.

[Erectile dysfunction after radical prostatectomy : patient information, contact persons, postoperative proerectile therapy]

BACKGROUND

Postoperative erectile dysfunction (ED) is one of the potential after-effects of radical prostatectomy. The aim of this study was to learn which caregivers inform the patients prior to the intervention about the risk of ED, which individuals the patients discuss this issue with, and whether the patients preoperatively consider use of a PDE5 inhibitor for proerectile therapy after the operation.

METHODS

Using the IIEF-5 questionnaire, the preoperative erectile function of 110 patients was evaluated after the hospital admission interview. The patients were asked who had informed them about the risk of postoperative ED. They were also asked in whom they had confided to discuss this issue and whether they were prepared to undergo postoperative proerectile therapy with a PDE5 inhibitor. The patients were subsequently assigned to one of two groups: group I, consisting of those with a preoperative IIEF score > or = 21, or group II, those with a preoperative IIEF score <21.

RESULTS

The answers given by groups I and II did not differ significantly. The median patient age was the same, 68, in both groups. In addition to being informed about postoperative ED by the hospital doctor on admission (100%), the patients were informed about this by the following individuals (results for group II in parentheses): board-certified urologist, 81.8% (74%); general practitioner (GP), 27.3%; partner, 12.1% (11.7%); self-help groups, 0% (2.6%); and friends, 3% (6.5%). Patients also discussed the risk of postoperative ED with the following individuals (results for group II in parentheses): local urologist, 66.7% (63.4%); partner, 45.5% (42.9%); hospital doctor, 39.4% (42.9%); GP, 21.2% (23.4%); friends, 9.1% (14.3); or no one, 3% (5.2%). Regarding whether patients were willing to undergo postoperative therapy using a PDE5 inhibitor, 36.4% in group I and 32.5% in group II said yes, 12.1% in group I and 11.7% in group II said no, and 51.5% in group I and 55.8% in group II were undecided.

CONCLUSION

Irrespective of the patient's erectile status, the hospital doctor and the local urologist informed the patients about the risk of postoperative ED. Satisfactory information delivered by at least two people occurred in over 70% of all cases. The most frequent confidant of the patient for discussing this issue was his local urologist. Fewer than 50% of the patients discussed this topic with their partners. Possible reasons for underestimating the importance of sexual function could be the frequent taboo status of sexuality as a discussion topic in relationships, as well as preoperative distress. These circumstances should be taken into account by offering sufficient information, including that on the availability of postoperative proerectile therapy, for both the patient and his partner as early as possible, i.e., at the stage of choosing a treatment option.

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Prostate cancer is the second most frequently diagnosed cancer in men in the United States. Many men with clinically localized prostate cancer survive for 15 years or more. Although early detection and successful definitive treatments are increasingly common, a debate regarding how aggressively to treat prostate cancer is ongoing because of the effect of aggressive treatment on the quality of life, including sexual functioning. We examined current research on the effect of post-prostatectomy radiation treatment on sexual functioning, and suggest a way in which patient desired outcomes might be taken into consideration while making decisions with regard to the timing of radiation therapy after prostatectomy.

Current management of erectile dysfunction after cancer treatment

PURPOSE OF REVIEW

Erectile dysfunction has a major impact on quality of life. Treating sexual dysfunction after cancer treatment requires special concern because of specific medical, psychological and social factors. This article presents the relevant experimental and clinical recent literature on rehabilitation of erectile function after surgery, external beam radiotherapy, brachytherapy or hormonal deprivation therapy for prostate cancer as it is the most studied model for erectile dysfunction management.

RECENT FINDINGS

Counseling and reeducation with a multidisciplinary approach seems to be both mandatory and effective in achieving erectile function recovery. Administration of proerectile drugs nightly or on-demand early after cancer treatment is probably the key factor of erectile rehabilitation. Several studies have highlighted the presumption of a potential role for phosphodiesterase type 5 inhibitors (PDE5-Is) in the prevention of endothelial damage related to ischemia-reperfusion and denervation following surgery or pelvic radiation. Larger multicancer, randomized, controlled trials are needed to assess the role of PDE5-Is in erectile dysfunction pharmacological prophylaxis and rehabilitation strategy.

SUMMARY

Erectile dysfunction postcancer treatment requires multimodal management with early administration of PDE5-Is, combined therapy to maintain erectile tissue oxygenation if necessary with PDE5-Is, intracavernosal injection and transurethral alprostadil or even vacuum erect device, psychological counseling considering erectile dysfunction as a couple's issue. The best modality to optimize postcancer erectile dysfunction management has not yet been standardized and is still challenging.

Importance of baseline potency rate assessment of men diagnosed with clinically localized prostate cancer prior to radical prostatectomy

INTRODUCTION

Erectile dysfunction (ED) is a common, and multifactorial medical problem with significant impact on quality of life. Knowledge about baseline potency is highly important in men undergoing treatment for prostate cancer (PCa) as it might influence judgments about impact of treatment and thereby treatment decisions.

AIMS

To analyze the baseline potency rate of men with clinically localized PCa prior to radical prostatectomy (RP). Furthermore, it was of interest to identify comorbid factors of preoperative ED.

MAIN OUTCOME MEASURE

Prevalence of preoperative ED and association between comorbidities and ED in men prior to RP in bi- and multivariable logistic regression analyses.

METHODS

Retrospective analysis of a large single center cohort of 1,330 evaluable PCa patients who were preoperatively assessed with the abridged 5-item version of the International Index of Erectile Function (IIEF) also described as Sexual Health Inventory for Men. Baseline potency and comorbidity rates, and their distribution were described. The risk of baseline ED associated with age, body mass index (BMI), the presence of hyperlipoproteinemia (HLP), non-insulin-dependent diabetes mellitus (NIDDM), hypertension, and depression were analyzed in bi- and multivariable logistic regression analyses.

RESULTS

Using the IIEF-5 cutoff value of 21, 48% demonstrated some degree of ED. Severe, moderate, mild to moderate, mild, and no ED was observed in 9.2, 4.0, 10.2, 24.7, and 52% respectively. In univariable analyses, ED significantly increased according to increasing age, BMI, presence of HLP, hypertension, NIDDM, and depression (P <or= 0.045). In multivariable analysis, age, BMI, NIDDM, and depression represented independent risk factors of baseline ED (all P <or= 0.005).

CONCLUSIONS

It is important to note that one in two men diagnosed with a clinically localized PCa experiences some degree of baseline ED of which 23.4% are moderate to severe prior to local therapy. Age, BMI, NIDDM, and presence of depression represent important independent risk factors of baseline ED.