title: Erectile dysfunction is predictive of all-cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy.
abstract: OBJECTIVE
  To evaluate the relationship between pre-treatment erectile function and all-cause mortality in patients with prostate cancer treated with brachytherapy.
  
  
  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.
authors: Tacoma/Valley Radiation Oncology Centers, Tacoma, WA, USA.
authors: Nathan
authors: N
authors: Bittner
authors: Gregory S
authors: GS
authors: Merrick
authors: Robert W
authors: RW
authors: Galbreath
authors: Wayne M
authors: WM
authors: Butler
authors: Jonathan H
authors: JH
authors: Lief
authors: Zachariah A
authors: ZA
authors: Allen
authors: Kent E
authors: KE
authors: Wallner
mesh_terms: D000368:Aged; D015415:Biomarkers; D001918:Brachytherapy; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D007172:Erectile Dysfunction / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications* / Q000532:radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers