Tacoma/Valley Radiation Oncology Centers, Tacoma, WA.
Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV; Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA, USA.
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.
To evaluate the relationship between pre-treatment erectile function and all-cause mortality in patients with prostate cancer treated with brachytherapy.
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.
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%).
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.
Written by:
Bittner N, Merrick GS, Galbreath RW, Butler WM, Lief JH, Allen ZA, Wallner KE. Are you the author?
Reference: BJU Int. 2011 Jul 6. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10280.x
PubMed Abstract
PMID: 21733074
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