FIRST-LINE treatments for erectile dysfunction (ED) are under-prescribed in patients with prostate cancer despite favourable clinical outcomes, a 2026 study has found.
Researchers emphasised that phosphodiesterase 5 inhibitors (PDE5i), including Viagra and Cialis, have been evidenced as safe and effective but are nonetheless underutilised.
ED and Prostate Cancer
ED affects more than 80% of patients with prostate cancer, all of whom report having poor or very poor erections.
Many cancer treatments, including radiotherapy, hormone therapy, and prostatectomy, can cause difficulty getting and maintaining erections.
For patients with prostate cancer who have been through treatment, the National Institute for Health and Care Excellence (NICE) guidelines recommend PDE5i as a first-line drug treatment for ED.
PDE5i block an enzyme that reduces blood flow, allowing more blood to reach key parts of the body and relax the muscles. This not only helps with ED but can also benefit organs such as the heart, brain, and lungs.
Prostate Cancer UK is calling for clinicians to consider prescribing PDE5i to more patients undergoing treatment for prostate cancer as early as possible.
PDE5i and Clinical Outcomes
Researchers found that evidence supports the association of PDE5i with favourable clinical outcomes in various health conditions often considered co-morbidities in patients with prostate cancer.
The evidence base supported the association of PDE5i and favourable clinical outcomes in cases of cardiovascular events, diabetes, and urological conditions including LUTS and BPH.
However, it was submitted that men who have unstable angina or angina occurring during sexual intercourse, regular or intermittent use of nitrates, hypotension, history of non-arteritic anterior ischaemic optic neuropathy, recent history of stroke, or renal impairment should not be prescribed PDE5i.
Under-Prescription
Researchers concluded that PDE5i use is underutilised within its NICE-recommended indications, even with evidential health benefits.
A 2025 cross-sectional survey found that on 13% of prostate cancer survivors were current users of PDE5i, compared with 9% of the general population.
The use of PDE5i treatments was historically restricted on the NHS due to their high cost, but patents on the drugs have expired over the last decade. This has made ED treatments cheaper and more accessible.
It is now possible for people to talk to their GP about getting PDE5i prescribed on the NHS.
References
Naranjo A et al. Evidence for the Additional Health Benefits Associated with Phosphodiesterase 5 Inhibitors when Used for Treating Erectile Dysfunction, with a Focus on Prostate Cancer Patients and Other Associated Conditions. World J Mens Health. 2026;DOI:10.5534/wjmh.250313.
Downing A et al. Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. Lancet Oncol. 2019;20:436-447.
National Institute for Health and Care Excellence (NICE). Erectile dysfunction: phosphodiesterase-5 (PDE-5) inhibitors. Available at: https://cks.nice.org.uk/topics/erectile-dysfunction/prescribing-information/phosphodiesterase-5-pde-5-inhibitors/. Last accessed: 3 March 2026.
Prostate Cancer UK. More men with prostate cancer could benefit from erection pills, new research shows. Available at: https://prostatecanceruk.org/about-us/news-and-views/2026/02/more-men-could-benefit-from-erection-pills. Last accessed: 3 March 2026.
Dahl AA et al. A controlled study of use and effectiveness of photphodiesterase-5 inhibitors in long-term survivors after curative radiotherapy for prostate cancer (PCa). Radiother Oncol. 2025;DOI: 10.1016/j.radonc.2024.110704.
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