Use It or Lose It: How important is it to be proactive about ED?

@pesquallie your last comment is sad but true, for some men life is over

@pesquallie no doubt ADT is associated with a higher degree of depression (especially, the literature suggests, affecting older men who are unmarried) and the risk of suicide is increased. Can you share your source for the 10% suicide rate you quote, as it seems much higher than any of the journal reviews I have examined.

And if depression accompanies chemical castration, then is not a more focused approach to mental health issues a requirement of PC therapy? Difficult as it may be to tolerate, ADT is life-saving in the management of PC.

I had different radiation but could have written this. I’ve tried Trimix (erections but painful) and have a vacuum device that works for only a couple of minutes. I have occasional nighttime/morning erections but nothing lasting or complete. Tadalafil 5 mg. Next month will make one year without climaxes, intercourse, or normal desire. Hopefully I’ll be off ADT next June and know by Christmas 2026 whether function returns or surgery is the best option. If you have a breakthrough, post it!

@rbtsch1951

I have seen suicide rates around 5% but do not remember the source. I suggested a higher percent because suicides are typically way under reported. Whatever the actual level, it is too high and needs to be addressed.

@pesquallie

I agree with you that depression is often under recognized and suicide underreported, and that it is important for patients and their health care providers to be aware of the same.

There is an increased risk of depression and suicide in men with prostate cancer overall:
https://wjmh.org/DOIx.php)
With respect to ADT there appears to be a slightly increased risk compared to the overall prostate cancer population, but not as high as the 5% or 10% you quoted. That is why I asked for sources.

In my own brief review of the literature, the following study demonstrated 49 suicides out of 5156 PC patients on ADT compared to 17 suicides out of 3752 non-ADT prostate cancer patients, a non-statistically significant difference:
https://onlinelibrary.wiley.com/doi/10.1002/pon.5186
I think it is important in this forum to
emphasize and understand the risks
of depression and suicidal ideation in the setting of prostate cancer overall and ADT in particular so that members realize that they are not alone with depression and feel comfortable seeking mental health care when needed. But it is equally important not to exaggerate the risk, frightening people from accepting scientifically supported treatment protocols that include ADT.