Phosphodiesterase Type 5 Inhibitor Use Following Radical Prostatectomy is not Associated with an Increased Risk of Biochemical Recurrence

Objective Recently, conflicting findings have been reported on the effect of phosphodiesterase type 5 inhibitor (PDE5I) use on biochemical outcome following radical prostatectomy (RP). Thus, we investigated the impact of PDE5I treatment following RP, including therapeutic strategy, timing, duration, and drug type, on oncologic outcomes. Methods We analyzed records of 1082 patients who underwent bilateral nerve-sparing RP for clinically localized prostate cancer (PCa) between 2005 and 2014. Patients were categorized according to PDE5I use within 2 years following RP: non-user, on-demand, and rehabilitation (daily PDE5I use for ≥3 months) groups. Associations of various factors with biochemical recurrence (BCR) were analyzed using a Cox multivariate proportional hazards model. Propensity score-matched analysis was also performed. Results Among the subjects included in our study, PDE5I use was as follows: 253 (23.4 %) non-users, 475 (43.9 %) on-demand users, and 354 (32.7 %) in the rehabilitation. Multivariate analysis showed that PDE5I use was not a significant factor with regard to BCR risk [hazard ratio 1.47 (0.765–2.826); p = 0.248). Among the PDE5I users, a strategy for PDE5I use (on-demand vs. rehabilitation), timing of initiating PDE5I treatment following RP, duration of PDE5I use, and type of PDE5I used were not associated with an increased BCR risk in multivariate analyses ( p = 0.304, p = 0.177, p = 0.332, and p = 0.105, respectively). In addition, PDE5I use was not associated with an increased risk of BCR among 478 matched cohorts ( p = 0.672). Conclusions PDE5I treatment following RP was not found to have any significant impact on biochemical outcome regardless of therapeutic strategy, timing, duration, and drug type. Such findings suggest that PDE5I treatment following RP is oncologically safe.