Health Report:

Erectile Dysfunction & Frequency of Sex

Muscle Strength & Mortality in Men

Cryoablation for Prostate Cancer

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Photo of Dr. Wascher

Last Updated:  7/13/2008

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


A few years ago, I reviewed a research paper that found a lower incidence of prostate cancer in men who frequently engaged in sexual intercourse.  The response of readers fell, predictably, along gender lines, with most male readers enthusiastically embracing this novel putative prostate cancer prevention activity, while many female readers took a less exuberant view of the results of this particular study.  Now, a new study in the American Journal of Medicine reports on the apparent relationship between erectile dysfunction (ED) and frequency of sexual intercourse among older men. 

In this Finnish public health research study, 989 men between the ages of 55 and 75 (average age was 59.2 years) were assessed with a validated ED questionnaire, and were followed for an average of 5 years.  The men were also questioned about coexisting ailments that are known to be associated with ED (among this cohort of nearly 1,000 men, 32% had hypertension, 12% had heart disease, 7% complained of depression, 4% had diabetes, and 4% had a history of stroke).  When ED-associated illnesses were statistically corrected for, the researchers were then able to assess the relationship between number of episodes of intercourse per week and the incidence of ED.

In this study, men reporting intercourse less than once per week had twice the incidence of ED when compared to the men who reported intercourse at least one time per week.  The authors of this study, therefore, concluded that more frequent sex is protective against the development of ED.

Human sexuality is complex both in terms of behavior and in terms of biology.  I wish that I could fully embrace the results of this study and its findings, but there are a number of weaknesses and potentially false assumptions involved in the authors’ conclusions.  First of all, this study has not, in my view, adequately excluded the very likely probability that the men who had intercourse less than once per week did so because, in fact, they already had significant ED, and that ED was, itself, a direct cause of reduced coital frequency.  Secondly, this study suffers from all of the potential weakness of survey-based public health studies, namely the potential for bias being introduced by the patients who completed the surveys, as well as, potentially, bias introduced by the people who constructed the surveys (and by those who tabulated the data from these surveys).  On top of these potential biases, it is well known (both in research circles and throughout general society) that men are notoriously “subjective” in answering questions related to their sexuality and sexual performance.  As the conclusions of this study rest squarely upon the accuracy of the answers that these men provided on the study’s questionnaires, one has to question both the accuracy of the data collected and, in turn, the conclusions based upon such data.  Likewise, this study did not evaluate the myriad social, economic, emotional, physical, pharmacological, and interpersonal factors that play such a powerful role in human sexuality.

There may indeed be some element of “use it or lose it” biology at work relative to the potency status of elder men.  However, I do not think that this particular study’s data is “potent” enough to conclusively prove that more frequent intercourse leads to a reduced incidence of ED (i.e., rather than the other way around).



There are many measures of overall health and fitness, many of them related to the extent of aerobic (cardiorespiratory) exercise capacity.  A new study, in the British Medical Journal, examines muscular strength as a predictor of mortality in men.  This study was performed by the Karolinksa Institute in Sweden, the University of Granada in Spain, the University of South Carolina, and the University of North Texas.

In this prospective clinical study, nearly 9,000 men between 20 and 80 years of age were followed over an average of 19 years.  All study volunteers were assessed for muscle strength and aerobic fitness using standard exercise physiology testing.  During the very long period of follow-up, 503 of the men died, including 145 deaths due to cardiovascular causes and 199 deaths due to cancer.  The researchers then adjusted for coexisting health factors in these men, including age, level of physical activity, smoking history, alcohol intake, obesity, other medical conditions, and a family history of cardiac and respiratory illnesses.  The male volunteers were then categorized into three groups, proportional to their age-adjusted level of muscular strength.

When compared to the men with the lowest level of muscle strength, the men with the highest level of muscle strength had a 29% lower risk of death due to cardiovascular disease and a 32% lower risk of death due to cancer.  The risk of dying due to any cause was also reduced by 23% for the men in the group with the greatest muscular strength. 

Even the men who exhibited muscle strength somewhere in between that of the men in the lowest and highest muscle strength groups appeared to also enjoy a lower risk of mortality.  The risk of death due to cardiovascular disease in this intermediate group of men was 24% lower than that of the “lowest muscle strength” group, while the risk of death due to cancer was 28% percent lower, and the risk of death due to any cause was 28% lower. 

Upon further analysis of their data, the authors of this study found that the association between muscular strength and a reduced risk of death due to cancer, or due to “all causes,” remained even when adjusting for the level of cardiorespiratory (aerobic) fitness.  However, among those patients with poor cardiorespiratory fitness, increased muscular strength was less protective against death due to cardiovascular disease.

In summary, increasing levels of muscular strength appear to be protective against death due to “all causes,” cardiovascular diseases (e.g., heart attack and stroke), and cancer.  Even among patients with poor cardiorespiratory fitness levels, increased levels of muscular strength still offered some protection against death due to various causes.  Given the strong interrelationship between muscular fitness, on the one hand, and overall health and fitness, on the other hand, it is not entirely clear if muscular strength is, by itself, a major contributor to the reduced death rates observed among “muscularly fit” men in this study (i.e., rather than muscular strength being only one of several interrelated health factors that, together, reduce the risk of mortality).  However, the authors of this study did adjust their statistical calculations in an effort to correct for health factors unrelated to muscular strength, and they still found that muscular strength, by itself, reduced mortality rates.  So, I’ll see you at the gym soon, in the weight training section….



New approaches to the treatment of prostate cancer are being investigated, in addition to existing surgical and non-surgical treatments.  Cryoablation is a technique that uses probes, inserted into the prostate gland, to freeze both the cancer and the surrounding normal prostate gland.  Although there is currently no data available from prospective, randomized clinical trials comparing cryoablation with standard therapies, there is a growing body of clinical data looking at the benefits and risks of cryoablation versus other more established therapies.

A new study in the journal Urology reviews the cumulative data, thus far, from an online data registry (the “COLD Registry,” or “Cryo Online Data Registry”) encompassing 1,198 patients who have undergone whole prostate gland cryoablation for prostate cancer.  The institutions participating in this study included the Cleveland Clinic, the M.D. Anderson Cancer Center, Columbia University, the University of Calgary in Canada, and the International Society of Cryosurgery in Trieste, Italy.

The patients included in this study were grouped according to tumor-related risk factors into low, intermediate, and high risk groups.  The average age of these men was approximately 70 years, and the average length of follow-up, to date, has been 2 years (136 of the patients have been followed for at least 5 years). 

Following whole gland prostate cryoablation, 77% of the patients were deemed to be free of detectable prostate cancer 5 years following treatment.  When broken down into separate prognostic risk groups, 85% of the low-risk group appeared to be disease-free at 5 years, 73% of the intermediate-risk group appeared free of disease at 5 years, and 75% of the high-risk group was clinically without evidence of recurrent prostate cancer at 5 years (using a different scoring system, 62% of the high-risk patients were clinically free of disease at 5 years). 

Recurrence rates confirmed by re-biopsy ranged from 15 to 38%, depending upon the clinical indications used to recommend re-biopsy (38% of the re-biopsies performed for rising prostate antigen, or PSA, levels in the blood were positive for residual or recurrent prostate cancer within the prostate gland). 

Complications associated with whole prostate gland cryoablation included breakdown (fistula) of the adjacent rectal wall (0.4%), incontinence of urine (5%), and impotence (91% of patients were impotent without the use of erectile dysfunction drugs or devices, and 75% were impotent despite using medications or devices).

Although a longer follow-up of the entire group of these patients may reveal very different trends, the findings of this study, thus far, compares rather favorably with other methods of prostate cancer treatment in terms of efficacy and complications.  However, as in other clinical studies of whole prostate gland cryoablation, the incidence of impotence following cryoablation appears to be significantly higher when compared to radiation therapy or nerve-sparing prostate surgery, while the incidence of incontinence of urine appears to be much lower for cryoablation when compared to other therapies.

Although this particular study offers very useful information, we will have to wait for the results of randomized prospective clinical trials that perform head-to-head comparisons between cryotherapy and other conventional prostate cancer therapies before cryoablation can be accepted as an equivalent (at least) therapy when compared to more established treatments.  A small randomized prospective clinical trial in Canada, which compared cryoablation with radiation therapy for localized prostate cancer, completed enrollment of all of its patients in April of 2007.  It will be at least another 5 years before mature data is reported from this trial.  If that data is favorable, then cryotherapy may become accepted mainstream treatment for at least some prostate cancer patients.  Until then, whole gland cryoablation should be considered an experimental treatment, and should be limited to properly accredited clinical research trials, in my view.

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center


Send your feedback to Dr. Wascher at rwascher@doctorwascher.net

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Copyright 2008.  Robert A. Wascher, MD, FACS.  All rights reserved.

Dr. Wascher's Archives:

7-6-2008:  Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008:  Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008:  Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008:  Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008:  Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008:  Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008:  Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008:  Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008:  Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008:  Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008:  Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008:  BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008:  Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008:  Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008:  Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008:  Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008:  Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008:  Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity 

3-2-2008:  Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008:  Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008:  Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008:  Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for  Down's Syndrome?

2-3-2008:  Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008:  Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008:  Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008:  Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008:  Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007:  Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007:  Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007:   Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality 

12-11-2007:  Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:  Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer 


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