In a recent study, diabetes mellitus (DM) was found to be predictive of lower erectile function recovery (EFR) at 2 years post-radical prostatectomy (RP).1
At 2 years, results showed that the proportion of men with DM who had an International Index of Erectile Function-Erectile Function domain (EFD) score of at least 24 and EFD of 10 or less was 14% and 63%, respectively, whereas the proportion of men without DM who had EFD of at least 24 and EFD of 10 or less was 32% and 42%, respectively. This suggests that DM is associated with lower EFD, reported investigators led by Jose Miguel Flores Martinez, MD, of Memorial Sloan Kettering Cancer Center, New York City, New York.
Because DM is a known risk factor for erectile dysfunction and erectile dysfunction is a common complication among patients who undergo RP, investigators sought to understand the relationship between DM and EFR post-RP.
A total of 2024 men were included in this study, all of whom had undergone RP with at least a 2-year follow-up. The International Index of Erectile Function (IIEF) was used to assess the population’s EFR, as well as a measured EFD score pre-RP and post-RP. Patients were excluded if they had received androgen deprivation therapy and radiation therapy before or after RP.
The investigators collected demographic, comorbidity, and pathological data. Univariate and multivariate logistic models were created and analyzed to evaluate predictive factors, such as DM and age. At the time of RP, this cohort of men had a mean age of 61.3 ± 7.1 years, a median baseline ED score of 27 (IQR = 19-30), and a median 2-year EFD score of 13 (IQR = 5-25). Ten percent of patients had DM with a mean pre-RP hemoglobin A1c of 6.6 ± 1.3%.
Additionally, the same regression models evaluated comorbidity profile associated with poor EFR post-RP. Forty-four percent of patients had hypertension, 51% had dyslipidemia, 14.5% had obstructive sleep apnea, 5% had a history of coronary artery disease, 8% were current smokers, and 34% were former smokers. Thirty-eight percent reported 2 or more comorbidities pre-RP and the median Gleason sum was 7.
Nerves sparing status was also assessed with a scoring system between 1 (preserved) and 4 (resected) for each side. The median nerve sparing status score was 3 (IQR 2-4), and the median EFD scores at 2 years with and without DM were 7 (IQR 3-16), and 14 (IQR 5-25), respectively (P < .001). Nerves were preserved bilaterally in 77% of this population and unilaterally in 16%.
“In our cohort, DM was a significant predictor of lower EFR at 2 years post-RP,” the authors concluded.
1. Flores Martinez J, Jenkins LC, Benfante N, et al. Analyzing the impact of diabetes on erectile function recovery after radical prostatectomy. Paper presented at 2021 Sexual Medicine Society of North America Fall Scientific Meeting; October 21-24, 2021; Scottsdale, Arizona. Abstract 144.