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Sandy Srinivas, MD


Common Urologic Medications and Risk for Cognitive Disorders in Patients Treated for Prostate Cancer

By: Chris Schimpf, BS
Posted: Tuesday, January 2, 2024

The journal Urology has published the results of a large, retrospective cohort study investigating possible associations between Alzheimer’s disease and common urologic medications used by patients who have undergone treatment for prostate cancer. Avery Braun, DO, of the University of California, San Francisco, and colleagues reported that phosphodiesterase-5 (PDE5) inhibitors and anticholinergics did not appear to be independently associated with risk—either increased or decreased—of developing Alzheimer’s disease or related dementias.

Noting that participants were generally healthy and diagnosed with prostate cancer at a young median age of 66 years, the researchers recommended dedicated, prospective investigations into the efficacy of PDE5 inhibitors in preventing and treating dementia. They also advised judicious stewardship of anticholinergics among older patients.

“Our results may provide some reassurance for short-term medication use in younger men experiencing common side effects from curative cancer management,” the investigators noted.

A total of 5,937 men diagnosed with prostate cancer at age 50 or older between 1998 and 2019 were included in the study, drawn from the Cancer of the Prostatic Strategic Urologic Research Endeavor (CaPSURE) registry. Participants underwent radical prostatectomy, radiation therapy (external-beam radiation or brachytherapy), primary androgen-deprivation therapy, or active surveillance/watchful waiting, and they had at least 5 years of follow-up after treatment.

The investigators reported that users of PDE5 inhibitors tended to be younger than nonusers at diagnosis (63 vs 70, P < .01) and had a lower incidence of comorbidities (P < .01). Users of anticholinergics tended to be older than nonusers (68 vs 66, P < .01) and had a higher incidence of comorbidities (P < .01). At 15 years after diagnosis, the researchers observed a 6.5% cumulative incidence of Alzheimer’s disease or related dementias. They also reported that PDE5 inhibitors (P = .07) and anticholinergics (P = .06) did not seem to be associated with dementia, regardless of primary treatment modality.

Disclosure: No disclosure information was provided.

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