Do Phosphodiesterase Type 5 Inhibitors Increase the Risk of Biochemical Recurrence After Radical Prostatectomy?

Area of Science:

• Urology
• Oncology
• Pharmacology

Background:

• Conflicting studies exist on the association between phosphodiesterase type 5 inhibitor (PDE5i) use and biochemical recurrence (BCR) after radical prostatectomy (RP).
• Determining the impact of PDE5i exposure on BCR risk is crucial for post-prostatectomy patient management.

Purpose of the Study:

• To investigate whether PDE5i drug exposure following RP increases the risk of BCR.
• To clarify the relationship between PDE5i use and oncological outcomes after prostate cancer surgery.

Main Methods:

• A retrospective review of an institutional database of 4630 prostate cancer patients treated between 2009 and 2020.
• Biochemical recurrence (BCR) defined as 2 PSA measurements > 0.1 ng/mL.
• PDE5i exposure quantified on a 0-3 scale; multivariable Cox proportional hazards models used to assess risk.

Main Results:

• No increased risk of BCR was observed with any PDE5i use (HR 1.05, P = .7) or duration of use (HR 0.98 per month, P = .055).
• 89% of patients used PDE5i at some point within 12 months post-RP, with 60% using it for ≥6 months.
• Baseline oncologic risk was lower in PDE5i users, suggesting residual confounding is unlikely.

Conclusions:

• PDE5i prescription after RP can prioritize quality of life.
• Patients using PDE5 inhibitors post-RP can be reassured regarding BCR risk.