Can ED be Prevented? The CON Position John P. Mulhall MD MSc FECSM FACS
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1 Can ED be Prevented? The CON Position John P. Mulhall MD MSc FECSM FACS Director, Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center
2 Bottom Line No, No, No!
3 Prevent 1. To keep from occurring 2. Prevention Treatment 3. Prevention Reverse (cure)
4 We should care because. Pfeiffer et al. Arch Gen Psych. 19:735, % of men years had sex weekly - 28% of men years The Janus Report (1993) - 83% of men years had sex weekly - 68% of women of same had weekly sex Charleston Heart Study Cohort (1995) - 40% of 80 year old having regular sexual activity Braun et al. IJIR. 12:305, % of year olds were having sex - 41% of year olds were having sex weekly Lindau et al, NEJM % of men >70 years sexually active - 30% of women >70 years sexually active
5 We should care because. Population Age (y) (%) Boston Area (MMAS) Cologne,Germany Iberian Peninsula, Spain Perth, Australia Krimpen, Netherlands London, UK Braun M, et al. Int J Impot Res. 2000;12: Martin-Morales A, et al. J Urol. 2001;166: Chew KK, et al. Int J Impot Res. 2000;12: Blanker MH, et al. J Am Geriatr Soc. 2001;49: Goldmeier D, et al. Int J STD AIDS. 1997;8: Fedman et al. J Urol 1993
6 We should care because. Worldwide prevalence will increase from 152 million men in 1995 to 322 million men by 2025 North America 9.1 million Europe 11.9 million Asia 113 million South/Central America and Caribbean 15.6 million Africa 19.3 million Oceania 0.9 million Adapted from McKinlay JB. Int J Impot Res. 2000;12(suppl 4):S6-S11.
7 Root Causes Diabetes Obesity Hypertension Dyslipidemia
8 Organic Causes of ED Percentage Distribution
9 Organic Causes of ED Percentage Distribution AGING
10 Major Risk Factors for ED: Aging Adapted with permission from Feldman HA, et al. J Urol. 1994;151:54-61.
11 Age and ED 2% reported first experiencing ED before age 40y 4% reported first experiencing ED 40-49y 26% reported first experiencing ED 50-59y 40% reported first experiencing ED 60-69y Ann Intern Med Aug 5;139(3):I22.
12 Reversing ED Sommers: Daily PDE5i reverses arteriogenic ED on duplex Doppler ultrasound (very limited study) Esposito: Exercise and change in diet improved EF (statistically yet likely not clinically meaningful) 1 1. Esposito K, et al. J Sex Med Jul;7(7):
13 Modifiable Risk Factors Derby et al, Urology 56(2):302, 2000
14 Truism What is good for your heart is good for your penis!
15
16 Bottom Line No robust data that ED can be prevented in the general population
17 Therapeutic Options Stop men aging Eliminate stress Eliminate cigarette smoking Abolish HG genetics? Prevent DM lag time, genetics Prevent hypertension lag time, genetics, behavior Prevent dyslipidemia lag time, genetics, behavior Prevent CVD lag time, genetics Prevent sleep apnea lag time, behavior Do not perform RP genetics? Oncologic philosophy Do not prescribe offending medications.
18 Aging Inescapable fact As our population lives longer, ED rates will increase Is ED related to age or para-aging phenomena Prognosis: Poor
19 Eliminate Stress Good Luck! Prognosis: Poor
20
21 Stop Cigarette Smoking Acute and chronic effects Battle with industry not over Prognosis: Fair
22 Abolish TDS Address risk factors for TDS Increase awareness of condition - and its sequelae Prognosis: Fair
23 Prevent DM Increase awareness of condition - and its sequelae Heavy focus on genetics research Focus of human behavior Prognosis: Fair
24 Prevent CVD Increase awareness of conditions - and their sequelae Early intervention Improve therapy Human behavior modification Genetics research Prognosis: Good
25 Decrease Prostate Cancer Treatment Trend in this regard Increasing focus on focal therapy Prognosis: Good
26 Offending Medications Awareness Better research Prognosis: Good
27 Summary The public health challenges that ED prevention faces are enormous from numerous stand-points - Financial - Patient motivation - Pharmaceutical industry resistance?
28
29
30 In Reality. No matter what our motivation is as researchers and clinicians. Men do not utilize health care resources Men are poor at following medical advice Men do not focus on their penis until it stops working
31 Ladies. Be aware.
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