ED in men screened for prostate cancer risk?

Risk for erectile dysfunction (ED) after prostate cancer treatment is commonly assumed to be a reason why many men avoid being tested for their risk for prostate cancer. Whether that is really true or not is actually not well understood.

In September 2006, men < 75 years of age and living in the Washington, DC, area were invited to participate in a prostate cancer screening initiative conducted by the George Washington University Medical Center.  As part of the screening initiative, all men were asked to complete the Sexual Health Inventory for Men (SHIM), which is a  well-validated questionnaire for the screening and diagnosis of ED.  Bianco et al. also collected information about primary care physician use, phosphodiesterase-5 (PDE5) inhibitor use, serum PSA levels, and DRE findings. The participants who registered SHIM scores of ≤ 17 or who were taking a PDE5 inhibitor (e.g., Viagra or Cialis) were considered to have ED.

The results of this study were as follows:

  • A total of 333 men participated in the program and 328 completed the SHIM questionnaire.
  • Of these 328 men
    • 123 (37.5 percent) met the above definition of ED
    • 30 (9 percent) were using a PDE5 inhibitor
    • 93 (28 percent) had an SHIM score of ≤ 17 or less.
  • Analysis initially suggested a significant difference in the prevalence of ED between African-American men (25 percent) and non-African-American men (41 percent) found to have a SHIM score of ≤ 17; however, this difference was not significant once we took account of the ages of the men concerned.
  • 108/328 of the men tested (33 percent) had no primary care physician, and of these 108 men, 24 (22 percent) had a SHIM score of ≤ 17 .

The authors report that, based on their study data, the probability of ED  in a prostate cancer screening population increases in a nonlinear fashion with age. They note that this finding is “consistent with the findings of previous reports.”

They also point out a more significant male health risk issue, which is that there is a strong association between ED and cardiovascular disease. Given this risk, the lack of any normal contact with a primary care physician probably presents a greater risk to the health of these men than prostate cancer.

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