Association Between Common Urologic Medications and Onset of Alzheimer's Disease and Related Dementias in Men With Prostate Cancer Managed by Different Primary Treatment Modalities

OBJECTIVE To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who under-went different primary treatments for prostate cancer.MATERIALS AND METHODS Patients (> 50 years) with prostate cancer (1998-2022) without Alzheimer's disease or related dementias were selected from Cancer of the Prostatic Strategic Urologic Research Endeavor Registry. 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.RESULTS Among 5937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, P < .01) with less CAD, CVA, DM (all P < .01); AC users were older (68 vs 66, P < .01) with higher incidence of comorbidities (P < .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 Alzheimer's disease or related dementias was 6.5% at 15 years. PDE5i (P = .07) and AC (P = .06) were not associated with dementia regardless of primary treatment modality.CONCLUSION 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 182: 161-167, 2023. (c) 2023 Elsevier Inc. All rights reserved.