Incidence and severity of ED in prostate cancer patients before treatment


Erectile dysfunction (ED) is a common medical problem with significant impact on quality of life. The existence of some degree of ED in patients with prostate cancer prior to treatment clearly has potential effects on outcomes of different treatments. Researchers at the Martini Clinic in Hamburg, Germany have now reported on baseline erectile function in prostate cancer patients prior to treatment with radical prostatectomy.

Salomon et al.  set out to  analyze the baseline potency rate of men with clinically localized prostate cancer prior to radical prostatectomy and to identify comorbid factors of ED preoperatively.

They conducted a retrospective analysis of 1,330 evaluable prostate cancer  patients treated at a single center and who were preoperatively assessed using the abridged 5-item version of the International Index of Erectile Function (IIEF) test (also known as the Sexual Health Inventory for Men).

The patients 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 was carefully analyzed, and the authors reported the following results:

  • Using the IIEF-5 cutoff value of 21, 48 percent of patients demonstrated some degree of preoperative ED.
  • Severe, moderate, mild to moderate, mild, and no ED were observed in 9.2, 4.0, 10.2, 24.7, and 52 percent of patients respectively.
  • ED increased significantly with increasing age, BMI, presence of HLP, hypertension, NIDDM, and depression (P ≤ 0.045).
  • Age, BMI, NIDDM, and depression represented independent risk factors for baseline ED (all P ≤ 0.005).

The “New” Prostate Cancer InfoLink, recognizing the inherent problems associated with retrospective analyses of this type, still believes that this is an important study. It basically demonstrates that one in every two men diagnosed with clinically localized prostate cancer already experiences some degree of baseline ED before any treatment, and that nearly 25 percent of these patients have moderate to severe ED prior to local therapy.

These data have potentially significant impact on the treatment decision process. The authors correctly suggest that conducting a baseline evaluation of each patient’s erectile function may be an important component of good clinical practice that should be a routine part of the clincial evaluation.

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