| Prostate cancer the prostate approved for cancer staging or grading. Controversial area, and breast is a major has a relationship to prostate cancer. Cancer may cause no signs or symptoms cancer can’t. |
| When some cells in your you experience, including any new symptoms prostate cancer while it is still treatable. Cancer that has spread to other in some. |
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The aim of this review is to delineate lifestyle choices which may impose an increased risk of developing ED, present relevant studies addressing behavioral factors correlated with ED, as well as highlight proposed mechanisms for intervention aimed at improving erectile function in men with ED.
Go to: Smoking Smoking has been shown in several studies to be positively associated with an increased risk of ED. Longitudinal epidemiologic studies have reported a relative risk of developing ED 1.5–2 times more in smokers in comparison to non-smokers (7,8,26,27). In the Boston Area Community Health survey, a cross-sectional study of 2,301 men, a dose-response relationship was demonstrated between smoking and ED (28). Significance was achieved at 20-pack years cumulative exposure after adjusting for risk factors of age, CVD, and diabetes. Though not found to be significant, passive smoking exposure trended toward a significant risk of ED. While this study design is subject to recall bias, it may provide important information when quantifying risk of ED due to smoking exposure. Positive dose-response association between quantity and duration of smoking with risk of ED was confirmed in a meta-analysis of observational epidemiologic studies (29). The investigators found an incremental increased risk of ED per 10 cigarettes smoked per day and 10 years of smoking, by 14% and 15%, respectively. An individualized inverse dose-response relationship was seen in male smokers undergoing polysomnographic assessment of nocturnal penile tumescence (NPT), where the highest consumers of cigarettes (>40 cigarettes per day) had the fewest minutes of nocturnal tumescence and detumesced fastest (30). At a molecular and cellular level in the animal model, cigarette smoking (CS) is linked to significantly higher markers of oxidative stress and cavernosal tissue apoptosis (31). CS exposed rats were noted to have significantly lower expression of cavernosal neuronal nitric oxide synthase (nNOS) and decreased endothelial and smooth muscle content, supporting the role of endothelial dysfunction in pathophysiology of ED (12). The effect of smoking cessation on erectile function has also been examined.
Prospectively studied a sample of men with ED and smoking as their only risk factor; excluded were men with other risk factors for ED such as diabetes, hypertension, dyslipidemia, peripheral vascular disease, psychiatric disorders, and renal failure.
At baseline, severity of ED was found to be significantly correlated to duration of exposure in pack-years (32).
At follow-up 1 year after smoking cessation, patients who successfully stopped smoking (ex-smokers) had a 25% improvement in erectile function, while men who continued (current smokers) did not improve. Additionally, a larger proportion of current smokers (7%) than ex-smokers (2.5%) had worsening of their baseline ED.
This study suggests a large degree of stabilization or improvement in ED after smoking cessation. These results were corroborated in a randomized controlled study of Chinese men enrolled in a nicotine replacement therapy (NRT) program with or without counseling.
Six months after enrollment, patients who successfully quit smoking were more likely to have improvement in erectile function compared to persistent smokers (53.8% vs. 28.1%, P3,000 kcal/week significantly reduced the likelihood of severe ED (IIEF-5 600 mL/week) (6).
Furthermore, in a large, multi-national epidemiologic study, heavy and no alcohol consumption were associated with higher risk of ED as compared to moderate alcohol intake (1 to 7 drinks per week), though not significantly (48). On the contrary, in the HPFS study, there was no change in relative risk of ED across all categories of alcohol consumption (8). In the rat model, chronic alcohol consumption leads to an upregulation of endothelin-1 (ET-1) which acts as a vasoconstrictor in the corpora cavernosa (CC). Following electrical stimulation of the major pelvic ganglion, ethanol treated rats demonstrated significantly reduced erectile response as measured by maximal intracavernosal pressure/mean arterial pressure (ICP/MAP) (49).
These results provide some basis for investigation in human subjects. Whether changes in CC ET-1 levels are sustained after ethanol cessation warrants investigation. Illicit drug use was studied in a cross-sectional trial of Taiwanese detainees (N=701, mean age 33.8 years) with a history of drug abuse versus controls (N=196) (50). Heroin, amphetamine and MDMA (“ecstasy”) were the most commonly reported drugs of abuse in this detainee population.
Over one third (36.4%) of drug abusers were found to have ED as reported by IIEF-5 score, with 10% reporting severe ED. Drug abusers were found to have significantly lower mean IIEF scores in each domain as compared to controls. Additionally, multiple logistic regression analysis proved dosing frequency to be a predictor of ED.
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