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Erectile dysfunction is predictive of all‐cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy
Author(s) -
Bittner Nathan,
Merrick Gregory S.,
Galbreath Robert W.,
Butler Wayne M.,
Lief Jonathan H.,
Allen Zachariah A.,
Wallner Kent E.
Publication year - 2012
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.2011.10280.x
Subject(s) - medicine , prostate cancer , brachytherapy , erectile dysfunction , cohort , cancer , prostate , urology , prostate brachytherapy , cause of death , disease , surgery , radiation therapy
Study Type – Prognosis (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Cardiovascular disease is a leading cause of death in prostate cancer patients. Pretreatment ED is a surrogate for vascular pathology. Aggressive treatment of medical co‐morbidity in prostate cancer patients may positively impact overall survival. OBJECTIVE• To evaluate the relationship between pre‐treatment erectile function and all‐cause mortality in patients with prostate cancer treated with brachytherapy.PATIENTS AND METHODS• In all, 1279 consecutive patients with clinically localized prostate cancer and pre‐implant erectile function assessed by the International Index of Erectile Function‐6 (IIEF‐6) underwent brachytherapy. • Potency was defined as an IIEF‐6 score of ≥13 without pharmacological or mechanical support. • Patients were stratified into IIEF‐6‐score cohorts (≤12, 13–23 and 24–30). • The median follow‐up was 5.0 years.RESULTS• The 8‐year overall survival (OS) of the study population was 85.1%. • The 8‐year OS for IIEF‐6scores ≤12, 13–23 and 24–30 were 78.0%, 92.8% and 91.4%, respectively ( P < 0.001). • Cardiovascular events accounted for a significant portion of deaths in each IIEF‐6 group. • When combined with other risk factors for cardiovascular disease, an IIEF‐6 score of ≤12 had an additive effect on all‐cause mortality (IIEF‐6 score of ≤12 and less than two comorbidities vs two or more comorbidities were 18.2% and 32.1%).CONCLUSIONS• A pre‐implant IIEF‐6score of ≤12 was associated with a higher incidence of all‐cause mortality. • Pre‐treatment erectile dysfunction is a surrogate for underlying vascular pathology, probably explaining the lower OS in this subset of patients. • Aggressive treatment of medical co‐morbidity is warranted to impactOS.