To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who underwent different primary treatments for prostate cancer (PCa).
Patients (>50 years) with PCa (1998-2022) without ADRD were selected from CaPSURE. Minimum medication use was 3 months. Fine-Gray regression was performed to determine the association between medication exposure and dementia onset ≥12 months after primary treatment in men matched on age, race, comorbid conditions, smoking, and type of clinical site, with competing risk of death.
Among 5,937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, p<0.01) with less CAD, CVA, DM (all p<0.01); AC users were older (68 vs 66, p<0.01) with higher incidence of comorbidities (p<0.01). Median months of use was 24.3 (IQR 12.1, 48.7) for PDE5i and 12.2 (IQR 6.1, 24.3) for AC users. Cumulative incidence of ADRD was 6.5% at 15 years. PDE5i (p=0.07) and AC (p=0.06) were not associated with dementia regardless of primary treatment modality.
In this retrospective cohort study, PDE5i and AC use do not appear independently associated with risk of dementia. Notably, our cohort was generally healthy and younger which may limit our ability to detect significance. We recommend prospective investigation into association between PDE5i and dementia and advise continued judicious stewardship of AC in older patient populations.
Urology. 2023 Sep 07 [Epub ahead of print]
A E Braun, J E Cowan, L A Hampson, J M Broering, A M Suskind, P R Carroll
Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA. Electronic address: ., Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA., Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Surgery, University of California, San Francisco, CA.