为了了解常见的泌尿系统药物磷酸二酯酶-5抑制剂（PDE5i）和抗胆碱能药物（AC）与患有前列腺癌（PCa）的男性在不同主要治疗方法下痴呆发病的关系。我们从CaPSURE中选择了1998年至2022年之间患有PCa但无ADRD的患者（年龄>50岁）。最少药物使用时间为3个月。采用Fine-Gray回归来确定药物接触与痴呆在主要治疗后≥12个月发病的关联性，匹配年龄、种族、共病状况、吸烟和临床场所类型，并考虑死亡竞争风险。在5937名男性中（53%使用PDE5i；14%使用AC），使用PDE5i的人年龄较小（63岁对比70岁，p<0.01），冠心病、脑卒中、糖尿病的发病率较低（p<0.01）。而使用AC的人较年长（68岁对比66岁，p<0.01），合并病状的发病率较高（p<0.01）。PDE5i使用者的中位服用时间为24.3个月（IQR 12.1，48.7），AC使用者的中位服用时间为12.2个月（IQR 6.1，24.3）。15年累积发生ADRD的比例为6.5%。无论主要治疗方式如何，PDE5i（p=0.07）和AC（p=0.06）与痴呆无关。在这项回顾性队列研究中，PDE5i和AC的使用似乎与痴呆的风险无关。值得注意的是，我们的队列整体上健康且较年轻，这可能限制了我们发现显著性的能力。我们建议进行前瞻性研究以探究PDE5i和痴呆之间的关联，并建议在较年长的患者群体中继续慎重使用AC。版权所有 2023年 Elsevier Inc.

To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who underwent different primary treatments for prostate cancer (PCa).Patients (>50 years) with PCa (1998-2022) without ADRD were selected from CaPSURE. 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.Among 5,937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, p<0.01) with less CAD, CVA, DM (all p<0.01); AC users were older (68 vs 66, p<0.01) with higher incidence of comorbidities (p<0.01). 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 ADRD was 6.5% at 15 years. PDE5i (p=0.07) and AC (p=0.06) were not associated with dementia regardless of primary treatment modality.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.Copyright © 2023. Published by Elsevier Inc.