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The Association Between Erectile Dysfunction and Depressive Symptoms in Men Treated for Prostate Cancer


  • Support for this research was provided by the Martell Foundation and the Pepsico Foundation.

Christian J. Nelson, PhD, Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, New York, 10021, USA. Tel: 646-888-0030; Fax: 212-888-2356; E-mail:


Introduction.  The relationship between erectile dysfunction (ED) and depressive symptoms is well established. However, this relationship is not well explored in men with prostate cancer. Limited data suggest men with prostate cancer may experience less ED bother than men with ED who do not have prostate cancer, implying that ED and depressive symptoms may not be associated in men with prostate cancer.

Aim.  To determine if ED is associated with depressive symptoms in men with prostate cancer.

Main Outcome Measures.  Assessments of quality-of-life (The Functional Assessment of Cancer Therapy [FACT-P]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), and erectile function. Erectile function was measured with one question from the FACT-P similar to that used by the Massachusetts Male Aging Study.

Methods.  Men with prostate cancer, and naïve of hormone treatment, completed the study questionnaires at a single time point.

Results.  The average age of the 339 men was 67 ± 10 years. The average time since diagnosis was 3.9 ± 3 years. When answering the question, “I am able to have and maintain an erection” on a 1 to 5 scale (5 representing the best function), the mean score was 2 indicating “a little bit.” On univariate analysis, erectile function and depression were associated, r = −0.12, P < 0.05. Other variables associated with depression were marital status, r = 0.11, P < 0.05; anxiety scores, r = 0.56, P < 0.01; and social support, r = −0.42, P < 0.01. On multivariate analysis, erectile function remained a significant predictor of depression, beta = −0.10, P < 0.05.

Conclusions.  Erectile function was associated with depressive symptoms in both univariate and multivariate analysis, indicating that ED is independently associated with depressive symptoms even though patients were approximately 4 years post diagnosis. These cross-sectional data suggest ED in men with prostate cancer can have lasting psychological effects. Nelson CJ, Mulhall JP, and Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. J Sex Med 2011;8:560–566.