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Currently, the most common curative treatment options for men with localized prostate cancer are radical prostatectomy, external beam radiotherapy and interstitial permanent brachytherapy and radical prostatectomy. Treatment decisions should particularly consider the specific risk and toxicity profile of a treatment method.

There is a lack of prospective studies focusing on the sexual quality of life of prostate cancer patients before and after a definitive conformal radiotherapy from the patients’ perspective. The aim of this study was to assess prospectively the incidence of erectile and predictive factors in a patient population treated with the same radiotherapy technique and a homogenous dose level, without antiandrogen treatment before radiotherapy or in the follow-up period. Patient age, comorbidities, prostate volume, planning target volume, pre-treatment sexual function and treatment of erectile dysfunction have been considered.

As with other studies, this study supports a progressively decreasing sexual function with longer follow-up intervals due to chronic radiotherapy effects, patient age and comorbidities. A stable level cannot be expected in a population of men with prostate cancer. However, chronic erectile dysfunction can very well be predicted shortly after radiotherapy, so that erectile dysfunction cannot only be regarded as a chronic effect of irradiation. As common after radical prostatectomy, the initiation of an early treatment could result in improved erectile function after radical radiotherapy.

Patient age and sexual function are the most important prognostic factors for the return of potency after radical prostatectomy. As shown in our study, these factors are equally of major importance after radiotherapy. The best predictor for preserving erections sufficient for sexual intercourse is the occurrence of spontaneous erections in the morning or night, before treatment. Diabetic patients are not only predisposed for erectile dysfunction before radiotherapy, but additionally for post- radiotherapy acquired erectile dysfunction.

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Many people who suffer a heart attack had never had any symptoms of heart disease. Of the roughly 5,000 individuals who die of sudden cardiac arrest in Sweden each year, two thirds had not had any known heart disease. But in men there is one thing that should constitute a advance sign of coming heart problems: impotence.

In some cases, male impotence can have neurological, psychiatric, and other causes. But the most common cause, accounting for up to four cases of five, is that the blood circulation in the penis has become so poor that erection is impaired, or no erection can occur at all. And if the circulation in these vessels has been affected by atherosclerosis, then it is highly probable that the same process is under way in the coronary artery in the heart.

In a dissertation from Lund University in Sweden, the physician Rasmus Borgquist has managed to show that this reasoning is correct.

“One of our studies shows that otherwise healthy men with impotence show signs of early atherosclerosis in the coronary arteries of the heart. In another study we saw that men with impotence evince a higher incidence of high blood pressure, high blood fat, abdominal fat, and other traditional risk factors for heart disease,” he says.

The conclusion is that men with impotence problems should seek care as soon as possible, since both their impotence and the possible threat of heart disorders can be counteracted with early intervention. The first priority involves changes in life style, such as quitting smoking, exercise, and altered diet, and then, if these are insufficient, ¬medication for lowering blood pressure and blood fat and also pharmacological therapy for treatment of the impotence as such.

“It’s probably easier to get men to accept changes in their life style if you can point out that they alleviate impotence, rather than talking about the risk of a heart attack sometime down the road. And there are studies that show that potency improves rather quickly in those who quit smoking and lose weight,” says Rasmus Borgquist.

The notion that there is a connection between impotence and heart disease was put forward in the mid 1980s. But this connection has been studied seriously only in recent years.

“Today there is a greater interest in these issues, both among the public and at drug companies,” claims Rasmus Borgquist. “On the one hand, several new drugs have appeared to combat cardiovascular diseases and their risk factors, and, on the other hand, potency drugs like Cialis Viagra Levitra have led many more men to seek help for impotence.“

There is still a certain “awkwardness factor” that makes some patients reluctant to seek help, and some physicians are hesitant to take up the matter. But in Rasmus Borgquist’s experience, once the physician has broached the subject, patients tend to respond frankly.

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