Takehiro Nakahara1, Jagat Narula2, Jan G P Tijssen3, Sunil Agarwal4, Mohammed M Chowdhury5, Patrick A Coughlin5, Marc R Dweck6, James H F Rudd7, Masahiro Jinzaki8, John Mulhall9, H William Strauss10. 1. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. 2. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: narula@mountsinai.org. 3. Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. 4. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Department of Vascular Surgery, University of Cambridge, Cambridge, United Kingdom. 6. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. 7. Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom. 8. Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. 9. Sexual and Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center, New York, New York. 10. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: harry.strauss@gmail.com.
Abstract
BACKGROUND: Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis. OBJECTIVES: To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients. METHODS: NaF positron emission tomography-computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography-computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake. RESULTS: Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94). CONCLUSIONS: NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.
BACKGROUND:Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis. OBJECTIVES: To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancerpatients. METHODS:NaF positron emission tomography-computed tomography bone scans were evaluated in 437 prostate cancerpatients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography-computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake. RESULTS: Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94). CONCLUSIONS:NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancerpatients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.