A significant proportion of men evaluated for prostate cancer treatment also live with diabetes, hypertension, dyslipidaemia, or coronary artery disease. These comorbidities influence staging tests, procedural risk, and recovery; they also alter the selection and timing of erectile dysfunction treatment in Singapore. Coordinating oncology and sexual-health decisions with a cardiometabolic review reduces avoidable complications and sets realistic expectations for function. Current urology guidance supports shared decision-making across all ED modalities and emphasises individual risk assessment rather than one-size pathways.
Staging and Local Therapy With Comorbidity In View
Risk stratification, using PSA, Grade Group, and MRI, drives the local control plan. For a suitable low-risk disease, this may mean active surveillance. For higher-risk disease, definitive therapy like surgery or radiotherapy is used. When the disease is locally advanced, multimodal approaches are common. When prior myocardial infarction, heart failure, or poor exercise tolerance is present, pre-operative optimisation and anaesthetic planning are incorporated before radical prostatectomy; for radiotherapy, image-guided, intensity-modulated techniques help contain dose to surrounding organs while systemic risks are managed concurrently. Early salvage radiotherapy after prostatectomy is generally more effective at lower PSA levels, which is relevant when delaying treatment to optimise medical comorbidity is being considered.
Anticipating Sexual Side Effects By Modality
Erectile function may decline after both surgery and radiotherapy, through neurovascular injury (surgery) or progressive vascular/neuropathic change (radiation). Diabetes independently impairs endothelial and cavernous nerve function, lowering response to ED therapies and slowing recovery. Discussing these mechanisms before prostate cancer treatment aligns expectations and allows earlier activation of rehabilitation once oncologic safety is confirmed.
Cardiovascular Clearance Before Resuming Sexual Activity
Men with established cardiovascular disease require a structured cardiac risk evaluation after their cancer therapy is complete. This should be done before they resume sexual activity or begin taking ED medications. Consensus statements recommend stratifying patients into low, intermediate, or high cardiac risk; high-risk individuals defer sexual activity until stabilised. This step is particularly important when planning erectile dysfunction treatment in Singapore that includes exercise-based rehabilitation and pharmacotherapy.
Medication Rules That Protect Patients
Oral phosphodiesterase-5 inhibitors (PDE5i) remain first-line for many men, but absolute and relative contraindications must be checked every time. Concomitant nitrate therapy (short- or long-acting) is an absolute contraindication due to profound hypotension risk; caution is needed with certain alpha-blockers and in poorly controlled cardiovascular disease. Clear counselling on timing, dosing, and drug separation is a core safety requirement in erectile dysfunction treatment in Singapore.
Penile Rehabilitation Adapted To Diabetes And Cvd
After nerve-sparing surgery, early penile rehabilitation aims to preserve cavernosal oxygenation and prevent fibrosis while neurological recovery occurs. Protocols commonly combine scheduled PDE5i and vacuum erection devices (VED); intracavernosal injections are added if responses are inadequate. Evidence supports the efficacy of PDE5i over placebo in the post-prostatectomy setting, though optimal timing and dosing schedules vary across studies; VEDs increase corporal oxygenation and can be started early. Diabetic men may need earlier escalation to injections because baseline endothelial dysfunction reduces PDE5i responsiveness.
When ADT is Part Of The Oncology Plan
If androgen deprivation therapy (ADT) is indicated (e.g., combined with radiotherapy for unfavourable risk disease or in metastatic settings), metabolic monitoring is embedded in the plan. ADT can worsen insulin resistance, increase fat mass, alter lipids, and elevate cardiovascular risk; baseline and periodic review of weight, blood pressure, lipids, and glucose, plus bone health measures, are recommended. These changes can aggravate ED and reduce treatment responsiveness, so ED pathways are adjusted accordingly, with earlier non-oral options considered if PDE5i efficacy falls.
Shockwave Therapy And Prostheses: Where They Fit
Low-intensity shockwave therapy (Li-ESWT) is used in select men with vasculogenic ED, but protocols and durability of benefit remain heterogeneous; it should be positioned as adjunctive and patient-specific rather than a universal solution. An inflatable penile prosthesis can offer reliable rigidity for men with refractory ED after cancer therapy, particularly those with diabetes. Success with this option, which works independently of neurovascular status, depends on thorough infection prevention and device counselling.
Practical Sequencing For Complex Patients
A practical, comorbidity-aware sequence could include:
- Complete oncologic staging and decide prostate cancer treatment;
- Baseline sexual function scoring with documentation of diabetes/CVD status;
- Cardiac risk stratification before resuming sexual activity;
- Initiate rehabilitation (PDE5i or VED) when oncologically safe;
- Escalate to injections of inadequate response, with glycaemic and blood-pressure optimisation in parallel;
- Consider a prosthesis when conservative measures fail and cancer surveillance is stable. This framework preserves safety while avoiding prolonged, ineffective therapy cycles.
For coordinated prostate cancer treatment planning with cardiometabolic risk review and guideline-based erectile dysfunction treatment in Singapore, contact the National University Hospital (NUH).
