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. 2010 Dec;106(11):1612-7.
doi: 10.1111/j.1464-410X.2010.09472.x.

The impact of preoperative erectile dysfunction on survival after radical prostatectomy

Misop Han  1 , Bruce J Trock, Alan W Partin, Elizabeth B Humphreys, Trinity J Bivalacqua, Thomas J Guzzo, Patrick C Walsh
Affiliations

The impact of preoperative erectile dysfunction on survival after radical prostatectomy

Misop Han et al. BJU Int. 2010 Dec.

Abstract

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.

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Conflict of interest statement

CONFLICT OF INTEREST

None declared. Source of funding: this study was supported in part by funds from the National Cancer Institute Grant CA58236 SPORE in Prostate Cancer, the Jahnigen Career Development from the American Geriatrics Society (M. Han) and by gifts from Dr and Mrs Peter S. Bing (B. Trock).

Figures

FIG. 1
FIG. 1
Non-prostate cancer-specific survival after radical prostatectomy (1983–2000).
FIG. 2
FIG. 2
Prostate cancer-specific survival after radical prostatectomy (1983–2000).
FIG. 3
FIG. 3
Overall survival after radical prostatectomy (1983–2000).
See this image and copyright information in PMC

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