Phosphodiesterase Type 5 Inhibitor Use and Disease Recurrence After Prostate Cancer Treatment

Phosphodiesterase type 5 inhibitor (PDE5i) use is common for management of erectile dysfunction. Single-institution studies have reported conflicting data on the relationship between PDE5i use and biochemical recurrence of prostate cancer (BCR) after radical prostatectomy.

To evaluate the association between PDE5i use and BCR after radical prostatectomy and radiation therapy in a nationwide population-based cohort.

This was a nested case-control study using the National Prostate Cancer Register of Sweden linked to the Prescribed Drug Register. Among men with localized prostate cancer who underwent primary radical prostatectomy or radiation therapy during 2006-2007 with 5 yr of follow-up, 293 had BCR after treatment (cases). For each case we identified 20 BCR-free controls (n=5767) using incidence density sampling.

Multivariable conditional logistic regression was used to examine the association between PDE5i use and BCR risk. Separate multivariable models including clinical variables for men undergoing prostatectomy or radiotherapy and including surgical pathology after prostatectomy were also analyzed.

PDE5i use was not associated with BCR after radical prostatectomy (odds ratio [OR] 0. 78, 95% confidence interval [CI] 0. 59-1. 03) or radiation therapy (OR 0. 98, 95% CI 0. 49-1. 97) after adjusting for marital status, education, income, prostate-specific antigen, clinical stage, Gleason score, and proportion of positive biopsies. Results were similar after additional adjustment for surgical pathology (OR 0. 86, 95% CI 0. 64-1. 16). Men whose cumulative number of PDE5i pills was above the median had a slightly lower BCR risk after prostatectomy in the clinical model, and no difference in BCR risk after adjustment for pathologic tumor features.

Our results from a population-based cohort suggest that BCR risk is not higher among men using PDE5i after prostate cancer treatment.

Erectile dysfunction medications are not associated with a higher risk of disease recurrence after prostate cancer treatment.

European urology. 2015 Dec 29 [Epub ahead of print]

Stacy Loeb, Yasin Folkvaljon, David Robinson, Thorsten Schlomm, Hans Garmo, Pär Stattin

Department of Urology, Population Health, and Laura & Isaac Perlmutter Cancer Center, New York University, NY, USA. Registers and Care Programs, Uppsala University Hospital, Uppsala, Sweden. , Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. , Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , Division of Cancer Studies, Cancer Epidemiology Unit, King's College London, London, UK. , Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden; Department of Urology, Uppsala University Hospital, Uppsala, Sweden.