Incidence of erectile dysfunction treatment after radical prostatectomy by Statin use in Finnish Nationwide Cohort Study

Abstract

Background

Erectile dysfunction (ED) is common after radical prostatectomy (RP) due to cavernous nerve damage. Risk of ED is also affected by vascular function. Statins prevent vascular events but their association with post-prostatectomy ED is unclear. We explored the likelihood of starting ED treatment after RP by statin use at the population level.

Methods

The study cohort included 14,295 prostate cancer (PCa) patients with no ED treatment prior to diagnosis of PCa treated with RP in Finland during 1995–2013. Information on use of cholesterol-lowering drugs and ED medication during 1995–2014 and penile prosthesis implantation during 1996–2014 were gathered from national registries. Risk of ED treatment initiation after RP was analyzed by pre-diagnostic and post-diagnostic statin and non-statin cholesterol lowering (NSCL) drug use with Cox regression model.

Results

Pre-diagnostic statin use or NSCL drug use overall had no association with risk of ED treatment initiation after RP. Post-diagnostic statin use was associated with a slightly increased risk of initiation of any ED treatment (HR = 1.07; 95% CI = 1.01–1.14). Patients with the longest duration of post-diagnostic statin use had a significantly decreased risk of PDE5 inhibitor initiation compared to non-users (HR = 0.43; 95% CI = 0.20–0.94). Among patients with no cardiovascular comorbidities, pre-diagnostic statin users had a significantly increased risk of initiation of injectable ED drugs (HR = 1.27; 95% CI = 1.04–1.55), however, no association with risk of any other ED treatment was observed.

Conclusion

Statin users have a slightly increased risk of ED treatment initiation after RP, which probably reflects the effect of the underlying vascular insufficiency.

Keywords:

• Prostate cancer
• Statin
• radical prostatectomy
• erectile dysfunction
• PDE5 inhibitor
• cohort study

Acknowledgments

This study was supported by research grants from Finnish Cultural Foundation, Pirkanmaa Regional Fund (no grant number) to Joentausta RM, research grant from the Cancer Foundation Finland (4706115) to Rannikko A and research grant from Academy of Finland (grant number 3121330724) and Finnish Cancer Society (grant number 3122800563) to Murtola TJ.

Disclosure statement

Joentausta RM: Virtual congress participation (Janssen). Siltari A: None. Rannikko A: Lecture and consultant fees from Janssen and Orion. Murtola TJ: Consultant fees from Novartis, Astellas, Recordati and Janssen; lecture fees from Ferring, Novartis, Janssen, Sanofi, Bayer, Roche and Pfizer.

Data availability statement

Data used in this study is available from the authors by request.

Additional information

Funding

This work was funded by The Finnish Cultural Foundation, Academy of Finland, Cancer Society of Finland and Cancer Foundation Finland.