Is ED a cause of depression in prostate cancer patients?

It is unlikely to come as any big surprise to the average prostate cancer patient who was potent before first-line therapy but has erectile dysfunction (ED) afterward that there might be an association between ED and depression after initial treatment for localized prostate cancer.

There is a well-established relationship between erectile dysfunction (ED) and symptoms of depression in men in general. However, some data have suggested that men with prostate cancer and ED are, in fact, less bothered by their ED than men who do not have this form of cancer.

Nelson et al. decided to clarify the situation by investigating whether there was a clear association between ED and symptoms of depression in men with prostate cancer attending their institution.

They used well-established survey tools to conduct assessments of patients’ quality-of-life, anxiety/depression, and erectile function. Patients with prostate cancer who had not ever received hormone therapy were asked to complete the study questionnaires at a single time point. The questionnaires asked patients to rate their ability to have and to maintain an erection on a scale from 1 through 5, with 5 representing the best possible erectile function.

The study data are as follows:

  • 339 men participated in the study.
  • The average age of the patients was 67 ± 10 years.
  • The average time since diagnosis was 3.9 ± 3 years.
  • The mean erectile function score was 2 (indicating that patients were only able to have and maintain an erection “a little bit” of the time).
  • Several variables were clearly associated with symptoms of depression on univariate analysis, including …
    • Erectile function (r = -0.12, P < 0.05)
    • Marital status (r = 0.11, P < 0.05)
    • Anxiety scores (r = 0.56, P < 0.01)
    • Social support (r = 0.42, P < 0.01)
  • Erectile function remained a significant predictor of depression on multivariate analysis.

The authors conclude that ED is independently associated with depressive symptoms in hormone therapy-naïve men with prostate cancer, even 4 years post-diagnosis.

As we said at the beginning, this was unlikely to come as any big surprise to hormone therapy-naïve patients who clearly lost erectile function after diagnosis and treatment of prostate cancer.

We should add a word of caution, however. This survey was carried out among patients managed at an institution with a specific program for penile rehabilitation after first-line treatment for prostate cancer. Could this fact have influenced the degree of importance and concern about erectile function in the men attending this institution? Possibly. In other words, the patients being seen at this institution may not represent “average” newly diagnosed prostate cancer patients.

6 Responses

  1. Would like to know if any such studies are known to include men whose first-line treatment included hormone therapy, then prostatectomy. I am one such person and 18 months post-surgery I am definitely living with significant ED.

  2. Reed:

    As far as I am aware this is the only study of this type and so no, there are no studies that include men who had received hormone therapy.

  3. Mike

    I agree the patients from that insitution are way above average!!


  4. What is infuriating about this issue is that apparently for many men the loss of sexual function and the shrinkage of their penis is preventable! In an article titled “Restoring Intimacy” in the Winter 2011 issue of Thrive magazine from the University of Michigan Health System there is a frank and clear explanation of what can be done. But none of my doctors ever even hinted that such help was available, and I suspect most men treated for prostate cancer suffer that same fate. To lose sexual function as a trade-off to dying is one thing, but to lose it unnecessarily because stupid doctors either don’t know or don’t care about how to prevent it is just ridiculous. No doctor should be allowed to touch a prostate cancer patient without knowing and sharing this kind of information!

  5. Bill:

    I only said they may not be “average.” Some of them might be above “average” with regard to their ability to get depressed and below “average” when it comes to their ED (‘cos they think too much!).

    [Note: This is an inside joke. Bill is a patient at the institution in question.]

  6. Mr. Arnold,

    You’re right, 100%. Even worse is that many, many men (some estimates suggest up to 40 percent) are treated years and years (if at all) before they need to be to “protect their lives.”

    It’s disingenuous to play the “but you might die” card when it’s clearly highly, highly, highly unlikely, and it’s unconscionable to provide prostate cancer treatment without either immediately providing or referring men for follow-up rehabilitation of sexual function.

    It’s terrible and unforgivable. You have every right to be furious and outraged.

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