18 F-Fluoride Positron Emission Tomographic Imaging of Penile Arteries and Erectile Dysfunction

Takehiro Nakahara, Jagat Narula, Jan G.P. Tijssen, Sunil Agarwal, Mohammed M. Chowdhury, Patrick A. Coughlin, Marc R. Dweck, James H.F. Rudd, Masahiro Jinzaki, John Mulhall, H. William Strauss

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1386-1394
Number of pages9
JournalJournal of the American College of Cardiology
Issue number12
Publication statusPublished - 2019 Apr 2


  • NaF
  • atherosclerosis
  • calcification
  • erectile dysfunction
  • sodium fluoride

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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