Hofer L, Radtke J P, Rapp C, Pahernik S, Teber D, Hohenfellner M, Hadaschik B
Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Urologe A. 2017 Apr;56(4):492-496. doi: 10.1007/s00120-016-0267-2.
Phosphodiesterase type 5 (PDE-5) inhibitors are widely used for penile rehabilitation and treatment of erectile dysfunction after radical prostatectomy. Recently, Michl et al. showed in a monocentric, retrospective and non-randomized analysis that PDE-5 inhibitors may cause higher biochemical recurrence rates after radical prostatectomy. This unexpected and serious adverse side effect of PDE-5 inhibitors was scrutinized on the basis of patients in our prospective tumor database.
We included 358 patients after radical prostatectomy with bilateral nerve-sparing and without neo- or adjuvant therapy during 2004 and 2015. In all, 65.9% of the patients regularly took PDE-5 inhibitors postoperatively, 34.1% did not. Patients with sporadic use were excluded from the primary analysis. We used Kaplan-Mayer analysis to compare biochemical recurrence rates in both groups (endpoint: PSA > 0.2 ng/ml or salvage therapy).
Both groups showed comparable clinical parameters. There was no significant difference in recurrence-free survival (p = 0.9334): 60 months postoperatively 90.4% of men with PDE-5 intake vs. 90.8% of men without intake of PDE-5 inhibitors were recurrence-free.
Although our analysis was constructed similar to the analysis of Michl et al., we could not confirm their results. Taken together with recent cohort study from Scandinavia, postoperative prescription of PDE-5 inhibitors seems to be safe and should be discussed with patients.
5型磷酸二酯酶（PDE-5）抑制剂广泛用于阴茎康复及根治性前列腺切除术后勃起功能障碍的治疗。最近，米歇尔等人在一项单中心、回顾性且非随机的分析中表明，PDE-5抑制剂可能会导致根治性前列腺切除术后更高的生化复发率。基于我们前瞻性肿瘤数据库中的患者，对PDE-5抑制剂这种意外且严重的不良副作用进行了详细审查。
我们纳入了2004年至2015年间接受根治性前列腺切除术且双侧保留神经、未接受新辅助或辅助治疗的358例患者。总共有65.9%的患者术后定期服用PDE-5抑制剂，34.1%的患者未服用。偶尔使用的患者被排除在主要分析之外。我们使用Kaplan-Mayer分析来比较两组的生化复发率（终点：PSA>0.2 ng/ml或挽救性治疗）。
两组的临床参数具有可比性。无复发生存率无显著差异（p = 0.9334）：术后60个月，服用PDE-5的男性中有90.4%无复发，未服用PDE-5抑制剂的男性中有90.8%无复发。
尽管我们的分析构建方式与米歇尔等人的分析相似，但我们无法证实他们的结果。结合斯堪的纳维亚半岛最近的队列研究，PDE-5抑制剂的术后处方似乎是安全的，应该与患者进行讨论。
