title: Association between preoperative erectile dysfunction and prostate cancer features--an analysis from the Duke Prostate Center Database.
abstract: BACKGROUND
  Erectile dysfunction (ED) is related to several co-morbidities including obesity, metabolic syndrome, cigarette smoking, and low testosterone, all of which have been reported to be associated with adverse prostate cancer features.
  
  
  OBJECTIVE
  To examine whether preoperative ED has a relationship with adverse prostate cancer features in patients who underwent radical prostatectomy (RP).
  
  
  METHODS
  We analyzed data from our institution on 676 patients who underwent RP between 2001 and 2010. Crude and adjusted logistic regression models were used to investigate the association between preoperative ED and several pathological parameters. The log-rank test and multivariate proportional hazards model were conducted to determine the association of preoperative ED with biochemical recurrence (BCR).
  
  
  METHODS
  The expanded prostate cancer index composite (EPIC) instrument was used to evaluate preoperative erectile function (EF). Preoperative normal EF was defined as EPIC-SF ≥ 60 points while ED was defined as preoperative EPIC-SF lower than 60 points.
  
  
  RESULTS
  Preoperatively, a total of 343 (50.7%) men had normal EF and 333 (49.3%) men had ED. After adjusting for covariates, preoperative ED was identified a risk factor for positive extracapsular extension (OR 1.57; P = 0.029) and high percentage of tumor involvement (OR 1.56; P = 0.047). In a Kaplan-Meier curve, a trend was identified that patients with ED had higher incidence of BCR than men with normal EF (P = 0.091). Moreover, using a multivariate Cox model, higher preoperative EF was negatively associated with BCR (HR 0.99; P = 0.014).
  
  
  CONCLUSIONS
  These results suggest that the likelihood for adverse pathological outcomes as well as BCR following prostatectomy is higher among men with preoperative ED, though these results require validation in larger datasets. The present study indicates that preoperative ED might be a surrogate for adverse prostate cancer outcomes following RP.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kimura
authors.forename: Lionel L
authors.initials: LL
authors.lastname: Bañez
authors.forename: Leah
authors.initials: L
authors.lastname: Gerber
authors.forename: Jim
authors.initials: J
authors.lastname: Qi
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Takefumi
authors.initials: T
authors.lastname: Satoh
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications* / Q000453:epidemiology* / Q000601:surgery; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen