Sep 05, 2018
Sildenafil. Tadalafil. Vardenafil. Avanafil. These may sound like complex drug names, but you probably know them by their brands names: Viagra, Cialis, Levitra, and Stendra. They are all in a class of drugs called phosphodiesterase type 5 (PDE5 inhibitors), and for many years now, they have helped thousands of men with erectile dysfunction (ED) get their sex lives back.
But like any drugs, PDE inhibitors have their side effects and risks. In 2014, we reported on a possible link between one of the drugs – sildenafil – and melanoma, the deadliest form of skin cancer. At that time, more research was needed, and men were advised not to change any of their medications without talking to their doctor.
The following year, scientists concluded that ED drugs probably didn’t cause melanoma, although they still found a link. Lifestyle factors could play a role, they said. Here’s how lead investigator Stacy Loeb, MD explained it in a press release at that time:
What our study results show is that groups of men who are more likely to get malignant melanoma include those with higher disposable incomes and education—men who likely can also afford more vacations in the sun—and who also have the means to buy erectile dysfunction medications, which are very expensive.
Where does the issue stand today? In June 2018, the Journal of Sexual Medicine published a new report, which we’ll focus on today.
Scientists analyzed information from a health records database, finding 610,881 men and women who were prescribed PDE5 inhibitors from 2007 to 2015. (Note: PDE5 inhibitors are used to treat more than ED. Patients of both sexes with pulmonary hypertension and lower urinary tract symptoms (LUTS) may take them, too. That said, in this study, 99.5% of this group was male.) On average, the patients’ first prescription was filled when they were about 51 years old.
The researchers also looked at records from over 2 million people with ED, pulmonary hypertension, or LUTS who were not prescribed PDE5 inhibitors. These people served as a control, or comparison, group.
In the group that took PDE5 inhibitors, 636 – a tenth of one percent - developed melanoma. Among people who didn’t take the drugs, 8,711 melanoma diagnoses were made, representing less than a third of one percent of the total group.
The researchers found no link between PDE5 inhibitor use and melanoma in people who had pulmonary hypertension or LUTS. Similarly, no relationship was found for any of the women.
And the men who took the drugs for ED? Interestingly, the researchers did find a link – and not only to melanoma. The authors also reported higher risk for basal cell carcinoma and squamous cell carcinoma, two other types of skin cancer that are more common than melanoma.
However, the authors explained that lifestyle factors could be involved:
Lifestyle factors, namely sun exposure, in this group of men is the likely cause of this increased risk and not the use of PDE5 [inhibitors] given that there is no common mechanism to account for carcinogenesis [formation of cancer] among these varied cancer types.
They added that people who took the drugs for other conditions were not at higher risk for melanoma compared to the non-users with the same health problems.
“Our findings support the safety of PDE5 [inhibitor] use in the United States,” they concluded.
Protect Yourself from Skin Cancer
While the news is encouraging, it’s still important for people to protect themselves from skin cancer, regardless of whether they take PDE5 inhibitors or not. Here are some tips to reduce your risk:
- Stay in the shade and wear protective clothing, like long sleeved shirts, long pants, and a sun hat.
- Use liberal amounts of sunscreen (SPF 30 or higher). The American Academy of Dermatology recommends about an ounce of sunscreen – the amount that would fit into a typical shot glass – for the average adult. Wear sunscreen even on cloudy days and reapply every two hours if you’re swimming or sweating.
- Keep in mind that water, sand, and snow can reflect the sun’s rays.
- Don’t use tanning beds.
- Check your skin regularly and see your doctor if you notice anything unusual.
Ask Your Doctor about ED
ED can be treated in a number of ways. If you’re having trouble with erections, call your doctor and schedule a checkup. And don’t hesitate to bring up any questions or concerns.
American Academy of Dermatology
“Prevent skin cancer”
“Types of skin cancer”
The Journal of Sexual Medicine
Shkolyar, Eugene MD, et al.
“Risk of Melanoma With Phosphodiesterase Type 5 Inhibitor Use Among Patients With Erectile Dysfunction, Pulmonary Hypertension, and Lower Urinary Tract Symptoms”
(Full-text. First published online: June 5, 2018)
“Study: Chances Are, ED Drugs Don’t Cause Melanoma”
(August 11, 2015)
“More Research Needed on Sildenafil/Skin Cancer Risk”
“Sildenafil and Skin Cancer Risk”
(June 24, 2014)