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

Eur Urol. 2016 Nov;70(5):824-828. doi: 10.1016/j.eururo.2015.12.013. Epub 2015 Dec 29.


Background: 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.

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

Design, setting, and participants: 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.

Outcome measurements and statistical analysis: 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.

Results and limitations: 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.

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

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

Keywords: Erectile dysfunction; Phosphodiesterase inhibitors; Prostate cancer; Recurrence; Viagra.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Drug Prescriptions / statistics & numerical data
  • Erectile Dysfunction / diagnosis
  • Erectile Dysfunction / drug therapy*
  • Erectile Dysfunction / epidemiology
  • Erectile Dysfunction / etiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging
  • Phosphodiesterase 5 Inhibitors / administration & dosage*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / epidemiology
  • Prostate / pathology
  • Prostate / surgery
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatic Neoplasms* / epidemiology
  • Prostatic Neoplasms* / pathology
  • Prostatic Neoplasms* / radiotherapy
  • Prostatic Neoplasms* / surgery
  • Radiotherapy / adverse effects*
  • Radiotherapy / methods
  • Risk Assessment
  • Sweden / epidemiology


  • Phosphodiesterase 5 Inhibitors