Daijiworld Media Network - London

London, Mar 3: First-line treatments for erectile dysfunction (ED) are being under-prescribed in men with prostate cancer despite strong evidence supporting their safety and effectiveness, a 2026 study has found.

Researchers noted that phosphodiesterase 5 inhibitors (PDE5i) — including Viagra and Cialis — are clinically proven to be safe and beneficial but remain underutilised in eligible patients.

ED affects more than 80 per cent of patients with prostate cancer, many of whom report poor or very poor erectile function. Treatments such as radiotherapy, hormone therapy and prostatectomy are known to impair the ability to achieve and maintain erections.

For men undergoing or recovering from treatment, the National Institute for Health and Care Excellence (NICE) recommends PDE5 inhibitors as the first-line drug therapy for ED.

PDE5i work by blocking an enzyme that restricts blood flow, thereby increasing circulation and relaxing muscles. In addition to helping with ED, studies suggest these drugs may also benefit cardiovascular health and other organs such as the brain and lungs.

Prostate Cancer UK has urged clinicians to consider prescribing PDE5i earlier and more widely to eligible prostate cancer patients.

Researchers found evidence linking PDE5i use to favourable clinical outcomes in several co-morbid conditions common among prostate cancer patients, including cardiovascular disease, diabetes and urological conditions such as lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).

However, experts cautioned that PDE5i are not suitable for everyone. They should not be prescribed to men with unstable angina, angina during sexual activity, regular or intermittent nitrate use, hypotension, a history of non-arteritic anterior ischaemic optic neuropathy, recent stroke or significant renal impairment.

Despite NICE recommendations and growing evidence of additional health benefits, researchers concluded that PDE5i remain underutilised.

A 2025 cross-sectional survey showed that only 13 per cent of prostate cancer survivors were current users of PDE5i, compared to 9 per cent in the general male population.

Historically, NHS prescribing of these medications was restricted due to high costs. However, patents have expired over the past decade, making ED treatments significantly more affordable and accessible.

Patients are now encouraged to discuss treatment options with their GP regarding eligibility for PDE5i prescriptions under the NHS.