Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are common diseases in middle-aged and elderly men. Although they share similar age distributions, their impacts on erectile function may differ. This study aims to compare the effective erection rates between BPH and PCa patients and explore their associations with hormone levels (e.g., testosterone, estrogen, prostate-specific antigen [PSA]), BMI, and other potential influencing factors.

This case-control study included age-matched BPH patients (control group, n=33) and PCa patients (case group, n=34). Effective erection was defined as achieving ≥60% rigidity for more than 10 minutes during nocturnal monitoring using Rigiscan. Data on baseline characteristics (age, BMI, medical history), erectile function, and hormone levels (testosterone, estrogen, PSA) were collected. Descriptive statistics were used to analyze baseline characteristics, and univariate analysis (t-test or Mann-Whitney U test) was performed to compare effective erection rates, BMI, and hormone levels between the two groups. Multivariate logistic regression was used to explore the independent associations of BMI, hormone levels, and other potential factors (e.g., PSA, disease stage, treatment) with effective erection rates.

A total of 33 BPH patients and 34 PCa patients were included. Baseline characteristics, including age (BPH group: 58.2±5.3 years vs. PCa group: 57.9±5.1 years, p=0.82) and BMI (BPH group: 25.3±3.1 kg/m² vs. PCa group: 26.1±2.9 kg/m², p=0.28), showed no significant differences between the two groups. The effective erection rate was significantly lower in the PCa group than in the BPH group (5.9% [2/34] vs. 18.2% [6/33], p=0.03). Univariate analysis revealed that PSA levels were significantly higher in the PCa group (12.3±8.7 ng/mL vs. 4.5±3.2 ng/mL, p<0.01), while testosterone levels (BPH group: 420±110 ng/dL vs. PCa group: 400±130 ng/dL, p=0.45) were within the normal range (300–1000 ng/dL) and showed no significant difference between the groups. Multivariate logistic regression analysis indicated that high PSA levels (OR=1.15, 95% CI: 1.05–1.26, p<0.01) and disease stage (OR=2.34, 95% CI: 1.12–4.89, p=0.02) were independently associated with reduced effective erection rates, while BMI (OR=1.02, 95% CI: 0.91–1.15, p=0.72) and testosterone levels (OR=0.98, 95% CI: 0.85–1.13, p=0.78) showed no significant association with effective erection rates.

The effective erection rate was significantly lower in prostate cancer patients compared to those with benign prostatic hyperplasia. This difference may be related to high PSA levels and disease stage, while BMI and testosterone levels showed no significant association. Future studies should further explore the mechanisms underlying the impact of PSA levels and disease stage on erectile function to provide insights for clinical interventions.