Managing ED and Enlarged Prostate: Insights from Steven Kaplan, MD

In an interview with Steven Kaplan, MD, chief medical officer at Aspargo Labs, director of the Men’s Wellness Program at the Mount Sinai Health System and professor at the Icahn School of Medicine at Mount Sinai, he emphasizes the importance of distinguishing erectile dysfunction (ED) from other sexual issues like libido or ejaculation problems. He also stresses that proper patient evaluation is key to identifying whether the issue is truly ED and discusses how lifestyle factors, medications and various treatments, including minimally invasive therapies, can manage ED and symptoms of an enlarged prostate.

Patients often mistakenly believe that medications like Viagra will address problems they aren't designed to treat, such as a lack of desire. Kaplan says it's essential to thoroughly listen to patients to correctly identify whether the issue is truly ED. If it is, lifestyle factors like smoking may contribute, but discontinuing these habits alone may not fully resolve the issue.

When ED is confirmed, oral medications are commonly prescribed, but patients need to manage their expectations. These drugs aren't magical fixes, he explains—understanding a patient's specific situation, including whether the problem is anatomical or psychological, is vital. Some patients, particularly younger men, may have just “lost their mojo,” while others may require different interventions, such as penile injections, sonographic therapy or prosthetics if oral medications fail.

As for the management of symptoms from an enlarged prostate, advancements in minimally invasive and surgical therapies have greatly evolved over the past few decades. Treatments like UroLift, Rezūm and Optilume offer promising results with fewer side effects. Surgical options have also advanced, including the use of lasers and robotic systems. However, Kaplan says, despite these innovations, the use of long-term medications remains prevalent, even though they can lead to negative side effects over time. The goal should be to move patients toward minimally invasive therapies earlier, reducing long-term reliance on medications and improving overall quality of life.

Kaplan is a member of the medical advisory board for Aspargo Labs.