Author + information
- Received May 16, 2018
- Revision received September 19, 2018
- Accepted October 18, 2018
- Published online March 25, 2019.
- Takehiro Nakahara, MD, PhDa,b,c,
- Jagat Narula, MD, PhDa,∗∗ (, )@LubbDup@IcahnMountSinai,
- Jan G.P. Tijssen, MD, PhDd,
- Sunil Agarwal, MD, PhDa,
- Mohammed M. Chowdhury, MDe,
- Patrick A. Coughlin, MDe,
- Marc R. Dweck, MD, PhDf,
- James H.F. Rudd, MD, PhDg,
- Masahiro Jinzaki, MD, PhDc,
- John Mulhall, MDh and
- H. William Strauss, MDa,b,∗ (, )@sloan_kettering
- aMount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
- bMolecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
- cDepartment of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- dDepartment of Cardiology, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
- eDepartment of Vascular Surgery, University of Cambridge, Cambridge, United Kingdom
- fBHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- gDivision of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
- hSexual and Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center, New York, New York
- ↵∗Address for correspondence:
Dr. H. William Strauss, Molecular Imaging and Therapy Section, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065.
- ↵∗∗Dr. Jagat Narula, Icahn School of Medicine at Mount Sinai, One Guggenheim Pavilion, 1190 Fifth Avenue, Mount Sinai Heart, N-126, Box 1030, New York, New York 10029.
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.
Dr. Nakahara was supported by the SNMMI Wagner-Torizuka Fellowship and Uehara Memorial Foundation Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Nikhil Joshi, MD, PhD, served as Guest Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received May 16, 2018.
- Revision received September 19, 2018.
- Accepted October 18, 2018.
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