Baseline erectile function and overall survival after radical prostatectomy

Introduction. A number of studies show an obvious connection between erectile dysfunction (ED) and the development of cardiovascular diseases (CVD), which occupy one of the leading places in the structure of mortality in cancer patients. In these circumstances, it is potentially promising to use the erectile function (EF) status before surgery as an indicator of the general health of patients and a predictor of overall survival (OS).

Purpose of the study. To study the causes of death of patients with prostate cancer (pca) after radical prostatectomy (RP) and evaluate OS depending on the preoperative EF.

Materials and methods. The study is based on a series of 2642 Rp performed at one medical institution between January 2003 and December 2017. Total of 1203 patients met the inclusion criteria and were divided into two groups: 620 patients with preserved EF or mild preoperative erectile dysfunction (ED) according to the five-item International Index of Erectile Function (IIEF-5) score (group 1) and 583 patients with mild-to-moderate, moderate or severe preoperative ED (group 2). The Mann-Whitney U test and chi-square test were used for statistical analysis. Survival was assessed using the Kaplan-Meier method with a log-rank test.

Results. A total of 101 deaths were observed in the study cohort; the median time to death was 72 months. Cardiovascular diseases (CVD) were the cause of death in 43.6% of patients, pc — 30.7%, other oncological diseases — 19.8%, other causes — 5.9%. There were no significant differences between the groups in age, body mass index, or degree of comorbidity. Biochemical relapse was observed in 19.8% in the group with preserved EF and 20.7% in the group with a baseline IIEF score <17 (p = 0.76). In the group with higher EF before RP, there was a tendency to higher 10- and 15-year OS: 92.8% and 83.7% versus 89.7% and 82.5%, respectively (p = 0.074). Significant differences between the groups were observed in the mortality from cVD: in the group with higher IIEF score, almost three times less patients died from CVD (12 and 32), and cardiovascular survival was 97.8% and 93.5% versus 96.7% and 91.6% after 10 and 15 years (p = 0.0014).

Conclusions. A lower baseline EF is associated with higher cardiovascular mortality in patients after Rp. The preoperative IIEF-5 score could be used as one of the predictors of further cardiovascular events and OS of patients. This can be helpful in preoperative selection of patients as well as initial treatment planning.

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