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Erection season

Posted Sep 29 2008 5:55pm

A woman told me that her husband had lost his erections after prostate cancer treatment. Her sister told me he had not. It took all my self-control to keep from starting a debate. Still, their words cause me to wonder: Do we use the same language in regards to erections? Not according to a recent panel of the American Urological Association. What it found has implications for how you react to the promises the doctor makes.

Over the last two years a panel of the American Urological Association reviewed over 400 articles about prostate cancer treatment. It asked a simple question: how do researchers define and measure erections? Among its findings was that definitions varied from the simple “erectile dysfunction” to the vague “concerns about sexual function.” It also found such different scales of dysfunction as a rating system from “none” to “a lot” and varying numerical scales such as “1 to 3″ or “1 to 5.” The panel concluded: “Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment.”

If definitions of erections vary, then maybe both sisters were right. Like the scientists, maybe they just used “poorly interpretable and inconsistent manners of assessment.” For the hundreds of thousands of men who face a prostate cancer treatment decision, such inconsistency represents a barrier to valid comparisons of treatments. Until definitions of erections are standardized and until the standard definitions are applied in appropriate studies, you and I will never have a valid scientific basis for claiming that one treatment preserves erections better than another (or that one doctor is better than another at preserving erections).

From a practical point of view, if you find a doctor who makes dogmatic claims of treatment superiority, you should be suspicious. If what you want is to understand how you will function after treatment, start with an assessment of what we know affects erections: age, obesity, smoking history, illnesses, medications, mood, and the like. These factors are as important, if not more so, as the treatment you choose.

Filed under: Living with Prostate Cancer

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