# Erectile Dysfunction and Its Impact on Health-Related Quality of Life in Prostate Cancer Patients: A Multicenter Cross-Sectional Study from Pakistan

## TL;DR

This study from Pakistan shows that prostate cancer patients often experience erectile dysfunction, which significantly affects their physical, psychological, and social well-being.

## Contribution

The study provides new insights into the prevalence and impact of erectile dysfunction in Pakistani prostate cancer patients, emphasizing the need for integrated sexual health care.

## Key findings

- Erectile dysfunction was reported in 40.8% of patients in the erectile function domain.
- ED showed strong correlations with reduced physical and social functioning in HRQoL.
- Sexual function domains explained 60% of the variance in health-related quality of life.

## Abstract

Background/Objectives: Prostate cancer (PC) is one of the most commonly diagnosed malignancies globally; depending on the treatment strategy used, erectile dysfunction (ED) is a frequently reported adverse outcome among PC patients. The current study evaluated ED prevalence among Pakistani PC patients and its effects on physical, psychological, and social well-being, aiming to address critical gaps in survivorship care for this population. Methods: A cross-sectional, multicenter, observational, questionnaire-based study was conducted in Rawalpindi and Islamabad, Pakistan, from February to April 2025. Health-related quality of life (HRQoL) among PC patients was measured using the Short Form Health Survey 36 (SF-36), while ED prevalence and severity were assessed by the International Index of Erectile Function (IIEF) instrument. Results: Among N = 400 PC patients, surgical treatments predominated (radical prostatectomy: 61.0%; n = 244), while hormonal (androgen-deprivation therapy: 31.5%; n = 126) and chemotherapy (23.3%; n = 93) were also commonly utilized. ED experience was high among PC patients in the erectile function (40.8%; n = 163) and in the intercourse satisfaction (45.0%; n = 180) domains; these showed moderately strong and significant positive correlations across all SF-36 domains, particularly physical functioning (r = 0.52; p < 0.001) and social functioning (r = 0.49; p < 0.001). Regression analysis confirmed sexual function domains explained 60% of HRQoL variance (adjusted R2 = 0.60). Conclusions: This study reveals high rates of treatment-related ED—and its biopsychosocial impact–among Pakistani PC patients, with significant negative impacts on HRQoL. The findings underscore the urgent need to integrate sexual health management into standard oncological care practices to improve holistic patient outcomes.