Objectives / purpose - Erectile dysfunction occurs in up to 85% of prostate cancer patients after radiation therapy or radical prostatectomy, which can elicit psychological distress. Our objective was to assess relief from depression and/or anxiety by comparing medication prescriptions and validated psychological questionnaire scores before and after a penile prosthesis implant.
Sample and setting - This study utilized a retrospective cohort of electronic health records compiled by Truveta from a collective of U.S. healthcare systems. The analysis included males with a history of prostate cancer diagnosis, regardless of treatment course, who also received an initial penile prosthesis implant (2010-2024).
Procedure - Prescriptions for an anti-depressant or anti-anxiety medication in the prior year were compared with the year following the penile prosthesis implant. In addition, men with depression and/or anxiety in the 3-year period prior to their penile implant were also identified based on the nearest of the following scores (Patient Health Questionnaire (PHQ) or Generalized Anxiety Disorder (GAD): PHQ9/GAD7>=5, PHQ4>=3, or PHQ2/GAD2>=2). After implant, the score closest to 1 year was reported (between 3 months and 3 years).
Results - Prior to the implant, n=192 men had medication prescriptions to treat depression and/or anxiety, and n=94 men had questionnaires with scores categorizing their symptoms as ‘mild’ to ‘severe’ (mean age 66). In the year after the penile prosthesis implant, 39.6% (95% CI: 32.3%-46.5%) of patients (76/192) discontinued their depression and/or anxiety prescriptions. Among men with both pre- and post-implant PHQ results, the proportion with ‘moderate’ depression symptoms shifted from 43.1% (22/51) pre-implant, down to 17.6% (9/51) post-implant (McNemar’s p=0.0008).
Conclusion and clinical implications - Validated psychological assessments and discontinued prescriptions demonstrate an association between a penile prosthesis implant and relief from depression. The results emphasize the importance of depression screening in patients suffering from erectile dysfunction after prostate cancer.