Phosphodiesterase-5 inhibitor (PDE5i) use after robotic prostate cancer surgery is associated with a decreased risk of death, according to research published in The World Journal of Men’s Health.

This finding is from a retrospective study that included 1843 men who underwent robot-assisted radical prostatectomy (RARP) from 2013 to 2021 at a single institution. In this group, 1298 patients were PDE5i users. From the full cohort, investigators propensity-score matched 529 PDE5i users with 529 nonusers.

The matched analysis showed that PDE5i use after RARP was associated with a 57% lower risk of death (hazard ratio, 0.43; 95% CI, 0.24–0.79; P =.007).

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The investigators matched the men in each group by age, Gleason grade group, pathologic T stage, preoperative American Society of Anesthesiologists physical status grade, and International Index of Erectile Function score.

The study excluded patients who had initiated PDE5i therapy 6 months after surgery, had less than 24 months of follow-up after surgery, had a heavy comorbidity burden, and were older than 70 years at the time of surgery.

With regard to study limitations, the investigators noted that the indication for PDE5i use was not available.

The investigators acknowledged that PDE5i use could be a marker of a healthier patient rather than a cause of better survival. “In particular, men who feel better and have increased sexual activity may be the patient population seeking PDE5i,” the investigators wrote.

They noted that the primary rationale behind their study is that PDE5i therapy may reduce the risk of cardiovascular death, and they cited research showing decreased all-cause mortality among PDE5i users with a history of coronary artery disease compared with nonusers.


Lee J, Kim HR, Heo JE, et al. Phosphodiesterase-5 inhibitor use in robot assisted radical prostatectomy patients is associated with reduced risk of death: A propensity score matched analysis of 1,058 patients. World J Mens Health. Published online January 3, 2023. doi:10.5534/wjmh.220063

This article originally appeared on Renal and Urology News