Premium
The impact of preoperative erectile dysfunction on survival after radical prostatectomy
Author(s) -
Han Misop,
Trock Bruce J.,
Partin Alan W.,
Humphreys Elizabeth B.,
Bivalacqua Trinity J.,
Guzzo Thomas J.,
Walsh Patrick C.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09472.x
Subject(s) - medicine , prostatectomy , prostate cancer , erectile dysfunction , hazard ratio , biochemical recurrence , proportional hazards model , urology , prostate specific antigen , body mass index , stage (stratigraphy) , univariate analysis , cancer , surgery , multivariate analysis , confidence interval , biology , paleontology
Study Type – Prognosis (case series)
Level of Evidence 4 PURPOSE Erectile dysfunction (ED) and cardiovascular disease (CVD) share etiology and pathophysiology. The underlying pathology for preoperative ED may adversely affect survival following radical prostatectomy (RP). We examined the association between preoperative ED and survival following RP. MATERIALS AND METHODS Between 1983 and 2000, a single surgeon performed RP on 2511 men, with preoperative ED (ED group, n = 231, 9.2%) or without ED (No ED group, n = 2280, 90.8%). We retrospectively analysed their CVD‐specific survival (CVDSS), prostate cancer‐specific survival (PCSS), non‐PCSS (NPCSS) and overall survival (OS) from time of surgery. RESULTS With median follow‐up of 13 years after RP, 449 men (18%) died (140 from prostate cancer, 309 from other causes). Kaplan–Meier analyses demonstrated significant differences in CVDSS ( P < 0.001), NPCSS ( P < 0.001) and OS ( P < 0.001), but not in PCSS ( P = 0.12), between the ED group vs No ED group. In univariate proportional hazards analyses, preoperative ED was associated with a significant decrease in OS, hazard ratio (HR), 1.71 (95% CI, 1.34–2.23), P < 0.001. However, in multivariable analyses, the association of ED with survival became non‐significant (HR, 1.25 (95% CI, 0.97–1.66), P = 0.111) after adjusting for other prognostic factors, such as age, preoperative prostate‐specific antigen (PSA) level, Gleason score, pathologic stage, body mass index and Charlson Comorbidity Index. CONCLUSIONS Preoperative ED is associated with decreased overall survival and survival from causes other than prostate cancer following RP. However, preoperative ED was not an independent predictor of overall survival after adjusting for other predictors of survival. Urologists should carefully assess pretreatment ED status to enhance appropriate treatment recommendation for men with prostate cancer.