HIGH RISK OF ERECTILE DYSFUNCTION IN MEN WITH COLORECTAL CANCER
February 7, 2012

In patients with colorectal cancer, especially those with rectal cancer, quality of life can be affected by bowel, bladder and sexual problems. Erectile dysfunction (ED) is often reported among men who have been treated for rectal cancer. It may result mainly from injury to pelvic nerves by surgery, radiation or chemotherapy. In addition, in every patient, individual risk factors have to be considered (age, co-morbidities).

In a recent study, Dowswell and colleagues assessed 28 men aged 34 to 80 years who had been treated for colorectal cancer. Despite some limitations (e.g., small group, descriptive approach), the study provides several interesting pieces of information. In survivors of colorectal cancer, ED is frequent. However, many patients do not seek help for ED for various reasons (e.g., unawareness of the association between experienced symptoms and colorectal cancer or cancer therapy, lack of knowledge about the possible treatment for ED, embarrassment, lack of confidence, perception of ED as a subject which is inappropriate for the medical office).

Even more importantly, among those who sought help for ED, almost none were receiving adequate, effective and affordable care. The patients emphasized lack or inadequacy of information about the risk of ED, inability or unwillingness of health care providers to speak about sexual function or even unintentionally offensive remarks, especially in regard to older men. In some cases, patients did not obtain any help from professional healthcare providers and sought medication on the internet.

Thus, from the practical point of view, three points are important. First, neither information about ED nor treatment for ED are incorporated into routine care of men with colorectal cancer.  Second, in these men, it may be necessary to explore problem of sexual function sensitively but routinely. Third, in case of older men, making assumptions about their sexual behavior or motivation (in particular, about lack thereof) may be inadvertently offensive.

Dowswell G, Ismail T, Greenfield S, Clifford S, Hancock B, Wilson S. Men’s experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study. BMJ. 2011 Oct 18;343:d5824. doi: 10.1136/bmj.d5824.

Increased Risk of Cardiovascular Mortality in Men with Erectile Dysfunction
July 7, 2011

Significant evidence exists linking the relationship between erectile dysfunction (ED) and the development of cardiovascular disease (CVD).  Moreover, ED has been shown to predict atherosclerotic cardiovascular events even in men even without symptomatic CVD (mortality hazard ratio = 1.43).

A recent cohort study of 2,318 Australian men sought to examine causes of death in men with ED, as well as their overall risk of death due to CVD.  Overall cardiovascular mortality in this study was 4%.  While the risk of mortality due to CVD was higher in men with diagnosed CVD prior to the diagnosis of ED, the median time interval between manifestation of ED and CV death was 10 years, predominantly in the 40-69 age group.

The relative risk of mortality from CVD was highest in men with ED with a history of hospital admission for cardiovascular events.  This finding implies a significant increase in the risk of CVD in men subsequent to the development of symptoms of ED.  Despite a statistically significant increase in the risk of cardiovascular mortality, the study revealed that only 35% of deaths in men with ED were related to cardiovascular etiologies, while 65% were from non-cardiovascular causes (deaths from cancer approached 29%).  The authors admit a potential limitation of their study centered on a small bias in that the medical records may have indicated a cardiovascular morbidity in some men who died from either CVD or cancer, yet this bias is thought to essentially be insignificant, and would not necessarily affect the median time interval between ED and CVD mortality.

Reference: Chew K-K, Gibson N, Sanfilippo F, et al.  Cardiovascular mortality in men with erectile dysfunction: increased risk but not inevitable.  J Sex Med 2011;8:1761-71.

Erectile Dysfunction and Chronic Prostatitis in Chinese Men
February 9, 2011

Erectile dysfunction (ED) has achieved prevalence rates of nearly 50% in age-adjusted cohort studies, and has been linked to heart disease, diabetes mellitus, hypertension, depression, obstructive sleep apnea, lower urinary tract symptoms, and chronic prostatitis.  A recent cross-sectional study from a cohort of 7,372 Chinese men aged 15 to 60 sought to evaluate the relationship between ED and chronic prostatitis (CP).

Interestingly, via survey, only 12% of men responded positively for having ED, with 17% of men having a score of < 22 on the IIEF-5.  Out of 7,372 men initially screened, 370 had chronic prostatitis, of whom 41% reported ED symptoms (35% according to IIEF scale).  The authors concluded that ED prevalence increased with advancing age, commensurate with previous studies including the Massachusetts Male Aging Study.  Quality of life issues are quite prominent in men with ED, as CP and prostatitis-like symptoms are also more common in men of advanced age.

The main tenet of this study offers insight into detailed epidemiology in Chinese men with ED and CP.  However, it is predominantly a causal analysis that admits that additional research is needed to elucidate a potential role that may uncover causative factors that link ED and CP.  The authors admit that their survey allowed for an open discussion of sexual health factors among Chinese men, yet psychological factors were not addressed.

Hao ZY, Li HJ, Wang ZP, et al.  The prevalence of erectile dysfunction and its relation to chronic prostatitis in Chinese men.  J Androl 2011;32:496-501.

Erectile Dysfunction and Metabolic Syndrome
December 12, 2010

A recent study conducted in Turkey aimed to determine potential factors affecting penile vascular flow and predictability of vascular flow in men with erectile dysfunction (ED). It has been well established that ED and coronary artery disease (CAD) share common pathophysiologic pathways, yet the relationship between metabolic syndrome and penile vascular flow in men with ED has not yet been evaluated.
One hundred sixty-three men with ED of mean age 51 years were evaluated, and completed the IIEF-5 (International Index of Erectile Function) questionnaire (mean score – 12). Metabolic syndrome was present in 46% of subjects. The aim of the study was to determine the relationship among penile Doppler ultrasonography, hypertension, obesity, fasting blood glucose, and cholesterol. The study found no significant correlation between arterial insufficiency andmetabolic syndrome, but did determine a significant correlation between penileveno-occlusive dysfunction and metabolic syndrome.
The authors concluded that penile Doppler ultrasonography may be useful in the evaluation of penile blood flow in men with metabolic syndrome and complaints of erectile dysfunction.

Reference: Koca O, Caliskan S, Ozturk MI, et al. Vasculogenic erectile dysfunction and metabolic syndrome. J Sexual Medicine 2010; 7:3997-4002.