Erectile dysfunction is predictive of all-cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy

OBJECTIVE To evaluate the relationship between pretreatment 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 comorbidity is warranted to impactOS.