PDE5 inhibitors can increase the risk of prostate cancer recurrence

The authors aimed to determine the effect of phosphodiesterase type 5 inhibitors on biochemical recurrence following prostate surgery.

Prostate surgery is a form of treatment that involves surgically removing the prostate gland which can cause erectile dysfunction in some patients. Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are drugs that treat erectile dysfunction that are taken prior to sexual activity. Tadalafil (Adcirca, Cialis), sildenafil (Viagra) and lodenafil (Helleva) are examples of PDE5 inhibitors used to treat erectile dysfunction.

Biochemical recurrence is a rise in prostate specific antigen (PSA – protein elevated in the blood in the presence of prostate cancer) that indicates that prostate cancer has returned. PDE5 inhibitors can prevent tumor growth and may influence biochemical recurrence.

The aim of this study was to determine how PDE5 inhibitors can affect biochemical recurrence following prostate surgery.

4,752 patients were used in this study with an average follow-up time of 60.3 months. 23.4% were treated with PDE5 inhibitors following prostate surgery while 76.6% of patients were not.

PDE5 inhibitors were classed as an independent risk factor in biochemical recurrence. Patients who took PDE5 inhibitors had a 38% increased risk of experiencing biochemical recurrence compared to patients who did not take PDE5 inhibitors. Five-year biochemical recurrence-free survival (patients who did not experience biochemical recurrence following treatment) rates were 84.7% in patients who received PDE5 inhibitors compared to 89.2% in patients who did not. 

The authors concluded that PDE5 inhibitor use following prostate surgery increased the risk of biochemical recurrence.

Further studies are needed to validate these results. 

If you are considering prostate surgery and have concerns regarding the impact of treatment on sexual functioning, please consult your doctor.