3373 - Erectile Dysfunction Severity as a Clinical Marker of High-Grade Prostate Cancer at Presentation
Presenter(s)
M. Sayan1, G. S. Miric2, R. W. Galbreath3, R. W. Fiano3, K. Wallner4, S. Moningi5, A. C. Smart6, J. E. Leeman7, M. T. King6, and P. F. Orio III8; 1Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ, 2Bethany College, Bethany, WV, 3Urologic Research Institute, Sarasota, FL, 4Department of Radiation Oncology, University of Washington, Seattle, WA, 5Cleveland Clinic, Cleveland, OH, 6Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 7Department of Radiation Oncology, Mass General Brigham, Harvard Medical School, Boston, MA, 8Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): As active surveillance expands to selected favorable intermediate-risk patients, improved identification of high-grade disease at diagnosis is increasingly important. We hypothesized that baseline erectile dysfunction (ED) severity identifies patients more likely to harbor high-grade prostate cancer at presentation.
Materials/Methods: We analyzed 2,445 consecutive patients treated with low-dose-rate brachytherapy (2001–2018) who completed a pretreatment IIEF-6 questionnaire without pharmacologic or mechanical support. ED severity was classified as severe (1–10), moderate/mild (11–24), or normal (25–30). Associations between ED severity and PSA, percent positive biopsies, Gleason group, NCCN risk category, and comorbidities were evaluated using chi-square and multivariable logistic regression models adjusting for age.
Results: Severe ED was significantly associated with higher PSA (p=0.008), greater percent positive biopsies (p=0.002), and higher Gleason group distribution (p<0.001). Patients with severe ED more frequently harbored Gleason group 4–5 disease compared with those with normal erectile function. ED severity was also associated with increased prevalence of hypertension, diabetes, cardiovascular disease, and tobacco exposure (all p<0.001).
Conclusion: Baseline ED severity identifies patients more likely to harbor high-grade disease at diagnosis, independent of age. In the era of expanding active surveillance, ED severity may represent a readily available host-level biomarker that identifies patients who could benefit from intensified diagnostic evaluation and monitoring.