Erectile%20dysfunction Diagnosis

Diagnosis

Thorough sexual, medical and psychosocial history
- Erectile dysfunction may be the first presentation of an underlying serious medical condition (eg hypertension, diabetes mellitus)

History

Sexual History

Patient consistently or recurrently is unable to maintain/attain an erection that is adequate for sexual satisfaction
May use validated psychometric questionnaires, eg International Index for Erectile Function (IIEF)

Physical Examination

Physical exam: Abdomen, penis, testicles, secondary sexual characteristics, lower extremity pulse, and digital rectal examination (DRE)
- A digital rectal examination is not mandatory in erectile dysfunction but should be done in the presence of genitourinary or protracted secondary ejaculatory symptoms

Laboratory Tests

Fasting blood glucose or HbA1c, lipid profile, testosterone assay to evaluate hypothalamic-pituitary-gonadal axis, urinary microscopy, etc as necessary
Prostate-specific antigen (PSA) is measured before initiating and at regular intervals during testosterone therapy

Assessment

Treatment of erectile dysfunction in patients with cardiovascular disease is associated with a small increase in the risk of myocardial infarction (MI) related to sexual activity independent of the method of treatment

Cardiovascular risk level:

High-risk - Should not receive therapy for sexual dysfunction until cardiac condition becomes stable
- Unstable/refractory angina
- Uncontrolled hypertension
- Systolic blood pressure (SBP) >180 mmHg
- Left ventricular dysfunction (LVD) or congestive heart failure (CHF) (NYHA class IV)
- Recent myocardial infarction or cardiovascular accident (CVA) within the past 2 weeks
- High-risk arrhythmias
- Hypertrophic obstructive and other cardiomyopathies
- Moderate-severe valvular disease

Intermediate-risk - Should be referred for further evaluation of cardiac status before receiving treatment
- Recent myocardial infarction or cerebrovascular accident (ie within the last 2-6 weeks)
- Left ventricular dysfunction or congestive heart failure (NYHA class III)
- Asymptomatic but ≥3 risk factors for coronary artery disease (CAD) (excluding gender)
- Moderate, stable angina
- Murmur of unknown cause
- Recurrent transient ischemic attacks (TIA)
- Heart transplant

Low-risk - All 1st-line therapies may be considered
- Asymptomatic coronary artery disease
- Less than 3 risk factors for coronary artery disease (excluding gender)
- Controlled hypertension
- Mild, stable angina that has been evaluated and/or being treated
- Post-successful coronary revascularization
- Uncomplicated previous myocardial infarction
- Mild valvular heart disease
- Left ventricular dysfunction or congestive heart failure (NYHA class I or II)

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.