Erectile function prior to prostate cancer treatment: a key to expectation management

The ability to recover good erectile function after treatment for localized prostate cancer is — rather obviously — dependent on the quality of patients’ erectile function prior to any treatment. However, good data on this latter factor is not as well documented as one might like.

An Australian research group has just reported data on the erectile function pre-treatment of a large series of men with localized prostate cancer scheduled for treatment with brachytherapy. We should note up front that the fact that these patients were opting for brachytherapy as first-line treatment for prostate cancer may imply that they were older than an otherwise comparable series of patients who had elected radical prostatectomy, but we can’t be sure about that.

Regardless of this minor “nit”, here is what Ong et al. have recently reported in the Journal of Sexual Medicine:

  • Their cohort of patients comprised a series of 699 patients, all of whom completed the International Index of Erectile Function (IIEF) five-item questionnaires pre-treatment between 2001 and 2013.
  • Prior to their treatment
    • 165/699 (24 percent) reported severe erectile dysfunction (ED).
    • 37/699 (5 percent) reported moderate ED.
    • 42/699 (6 percent) reported mild to moderate ED.
    • 129/699 (17 percent) reported mild ED.
    • 335/699 (48 percent) reported no ED.
  • Age, diabetes, and hypertension were independently associated with ED on multivariate analysis.
  • A diagnosis of diabetes was strongly associated with worse ED (odds ratio = 2.6).

The authors conclude that:

  • “ED is common among patients with localized prostate cancer prior to any curative treatment.”
  • “Assessment of baseline ED is important prior to curative treatment of prostate cancer.”

Without any assessment of baseline ED prior to treatment, it is impossible for any patient to be given a realistic set of expectations of the risks and realities of erectile function or dysfunction post-treatment, regardless of the type of treatment he is being offered.

However, if the patient isn’t honest with himself and his doctors up front about the realities of his erectile function prior to treatment, then all bets are going to be off! To that extent, it is always very difficult, in assessing the validity of studies like this, to know exactly how honest the patients were being up front. Men have an unsurprising tendency to “puff up” their own perceptions of their erectile function … and therefore the accuracy of data like those reported by Ong et al.

One Response

  1. One thing I encourage patients to do before treatment is to fill out the Sexual Health Inventory for Men (SHIM) form. Anyone with a pre-treatment score below 12 should alert his doctor — it may be an early indicator of cardiovascular disease or other illness. I hope the treating doctor will take baseline and follow-ups as well, and the patient will be honest with himself and his doctor. However, maybe if it’s private, the patient will be more honest. Then he can track his own progress after treatment. There are other validated questionnaires like EPIC, but the scoring is less straightforward.

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