Sildenafil for ADT side effect?

[Danskor]

I have had total ED since my first 3 month Eligard injection on August 11. I had my second injection today, Nov. 3. My Medical Oncologist is a DO and thinks I may be on ADT for a total of 18 months. I may start 28 sessions of EBRT soon. I'm worried about penile atrophy. Would it be a good idea to ask my urologist for sildenafil to prevent penile atrophy? I not interested in pumps, injections or implants, etc. at the present time. Just recently diagnosed (June 2022) and would be grateful for any advice. Thanks.

[tango65]

This is a review article about this subject:

ncbi.nlm.nih.gov/pmc/articl...

[Tall_Allen]

Nightly dose of sildenafil can keep the blood flowing.

[fireandice123]

I’ve taken a 40 mg daily maintenance dose of Sildenafil to fight the ED side effect of ADT for about 5 years. If sex is imminent I up the dose to 80 mg. It has worked for me. I’m able to achieve an erection. It’s not as good or as lasting as it was before ADT but I am able to have sex.

[Hidden]

viagra works by increasing blood flow for erections. I can only tell what I did. With Brachytherapy and IMRT the side issue is trauma to existing capillaries needed to increase blood flow. I took 12.5 mg Viagra twice a week. When u started a Lupron/Eligard, I continued. Having a vascular network is important. I ran this by my Cardiologist and Radiation Oncologist, then I ran it my my Medical Oncologist...... all concurred that it made sense and certainly would not hurt me. When I continued to have erections after hormone injections... wasn’t as stalwart as before, but stuffable, I told my MO, his response was that he was glad I could have a response... but he was surprised that I had the desire...... pretty rare.... anyway, I say protect your vascular network that is important to bring blood for erections. BTW, I was on a Lupron/Eligard for six years..... the hard part was having the desire...... good luck. Oh, I do not believe atrophy is what the word that you are looking for. .... rather than maintaining your blood supply network .... hopefully you too might have desire every once in a while... good luck.

GD

[Danskor in reply to Hidden]

Thank you for the encouragement and sharing your story. All of the replies to my post gave some good information. They are helpful and are appreciated.

[cesces]

Don't forget you can do injections.

They work through another mechanism.

[London441]

I understand you are ‘not interested in pumps and injections’ but if if are serious about preventing atrophy then get busy down there. Pills help a little, but you’ll get much better results adding regular stimulation than taking the pills only

The challenge is to want to do the work, since the near complete testosterone suppression of ADT kills libido completely for most. For me it was like a job I had no interest in doing. I wouldn’t say I was depressed about the ED, I simply didn’t care.

I regret not taking action a little now, although I can’t say it would have mattered anyway. RP often results in permanent ED despite ‘nerve sparing’, which I cynically put in quotes for a reason. Fortunately you still have your prostate if I’m correct.

Your odds will improve if you are consistent with the stimulation regardless of low or absent libido..

[fireandice123 in reply to London441]

Yeah, lack of desire is my problem now. While I can physically have sex I just don’t feel like doing anything sexual and surprisingly I don’t really care. It’s ironic. Sex was very important to me before. Still for the sake of my wife and the hope I won’t always feel this way I soldier on as best I can. I really don’t want my junk just to shrivel up. That just doesn’t feel right. Very emasculating.

[EdinBmore]

I was in a study regarding impact of PCa upon one's sexual life; from the general - the emotional/social/feeling side of life - to the very specific (how to use a pump, toys, videos). The study provided sildenafil 60 mg 3x wk, literature, videos...and, although you said that you're not interested in them...a pump. Manufacturer was NuPath. Although my interest in sex was 0, I used the pills and pump. It was an effort but I'm glad that I did. Although there was some genital shrinkage, it was not as bad as I fear it might have been without the meds and pump. Take home message: you might want to reconsider your opposition to the pump. For whatever it's worth, I involved my partner and we had fun with all of it.

EdinBaltimore

[TylexGP]

I would ask for silendafil I take 25 mg per day to help with blood flow to penile tissues. On days we plan on being intimate I use Trimix. That is what works for me. Like others have said you need to do what you can to increase blood flow. I am fortunate I can still achieve an erection but I need the Trimix to have an erection stiff enough for. intercourse.

[Tommyj2 in reply to TylexGP]

how much is the trimix costing you…if you don’t mind sharing?

[TylexGP in reply to Tommyj2]

$95.00 a 5 ml vial including shipping and 10 syringes.

[Tommyj2 in reply to TylexGP]

do you get 10 “sessions” from this one vial?……any other questions I’ll ask off group

[TylexGP in reply to Tommyj2]

I use 15 units .15ml) So I get well over 10 per vial.

[jastf]

Agree with Cialis 5mg daily.

[London441]

We are all different for sure. I have taken 5 mg Cialis for a long time now, but little has changed. As with testosterone, pre-diagnosis levels matter, but again they were of no help to me. I had very high T and superb function for my entire adult life right up to diagnosis.

After RP the loss in length and girth was obvious. Function began coming back in a few months but then came the additional treatment. The Lupron and IMRT pretty much finished off what was once a finely tuned machine, although I say so myself. Actually I still have witnesses lol.

For me it was the ADT that really changed everything. Yes I am older now but I’m a very fit and strong 66 with no other health issues. Regardless, even with full return of testosterone my drive is nothing like it was. Without getting too introspective, I just don’t think I’m the same psychologically as well as physically.

My wife is older and not nearly as interested as she once was, and is actually glad I’m not ‘packing heat’ as before. She is a bit dryer and penetration had already become uncomfortable at times. The combination means very little intercourse for us. Everything else is still on the table of course. It wouldn’t surprise a lot of you that our relationship is stronger and more loving than ever despite the change.

Refusal to accept age related changes is sexual attractiveness, prowess, function stamina etc etc makes many a older man bitter, but I am nothing of the sort. The treatment process decimated my sexual life, but I’m also off all drugs for more than 2 years and disease free of stage T3b Pca so far.

This is quite the fair trade in my mind, even I’d NEVER choose a prostatectomy as primary treatment if I had to do it over.

Sexually I left it all out on the field, as the athletes sometimes say. Strange gifts abound for us as time goes by if we are awake to them I think. Speaking strictly for myself, this ordeal has been one.

[Danskor in reply to London441]

Thanks for sharing your story. Fortunately for me (I think), my Drs. don't think RP is for me. I'm only about 3 months into a possible total of 18 months of Eligard shots. Very soon I will probably start 28 sessions of EBRT. I'm getting some good information from my fellow warriors on this site. Thank you.

[PSAed in reply to London441]

Thank you for being so honest. I had 2 years of LUCRIN (LUPRON ) and while I still have some function below the belt, I've lost a lot, about 1 1/2" to 2" I'd say. Naturally it does bother me .But if I can get the same results from the overall treatment as you've had I might be more accepting, its still early days for me to make a call.

[Hidden]

I think they usually prescribe daily low dose cialis (Tadalifil). Whichever one you go with here's the suggestion -- have them print you out the prescription, with plenty of refills. Then go to goodRx.com and print out a coupon, which will require you to pick out a pharmacy like Costco or Walgreens, then take that coupon and script to the pharmacy and put in your order. I don't know of any insurance that will pay even a little for these meds. I got qty 30 20 mg Cialis for less than $20 at Costco not long ago.

[London441]

I concur! Good RX is very good.

[SierraSix in reply to London441]

I paid $12.50 (shipping included) for a 90 day supply of 5mg Tadalifil from Mark Cubans costplusdrugs.com/

[MateoBeach]

You are in one way fortunate that you are not on lifetime ADT, but the 18 months. So you can look for the return of sexual function and libido after your testosterone recovers. Knowing that, It’s “Use it or lose it.” So you can benefit from a penile protection / rehab program. Sildenafil 20-40 mg or Cialis 5-10 mg most days and get some wood. A pump is quick and easy for that. Bonro is a simple system. And count down the months. Trimix certainly works for special occasions.

[Carlosbach]

Danskor:

I posted the following a few weeks back, but I think it is appropriate to your post...

My doctor had told me that the inability to get an erection was to be expected and that there was nothing I could do to prevent this loss. He also said that I would also lose my libido. WRONG!

About 3 months into the treatment I lost my ability to get and sustain an erection. My T was at non-detect levels, (where it has remained). I thought my penis’ sex life was over, but I had read that it is important to maintain the erectile tissue, so I tried a pump. Not much success, but it did increase the blood flow to my penis. I use the pump most days, not for sex, but to maintain circulation. After a while I thought the pump was a bust, but I was determined to not give up hope for a miracle. And then,… last November my wife and I were cuddling (naked), and wee willy raised his head. We had a blast! And it was very affirming to be able to achieve penetration, even if my erection is smaller now.

My wife and I determined to do everything we could to enjoy our rekindled sex life. In order to maintain my ability to achieve an erection I tried Viagra, but suffered from headaches. I finally got a prescription for Trimix and I use it 3 times a week.

I have not regained my normal libido, but our sex is the highlight of our days, and we are busier in the sack than two 17 year-olds. We make love at least once a day, every day, unless we are apart, but we more than make up for those separations.

I can't speak for others, but 2 plus years into treatment - life is pretty damn good. Would not have bet $5 on that the first 6 months of ADT, but glad I pushed through.

[Mrtroxely]

I did have the same worries...Now my nuts have shrunk, 1 breast has enlarged(thanks xiandi) and stiffys are rare!!!!

Now My focus is on staying alive with a good quality of life....

If I only have 3-5y I'll work around it ..

[awb1 in reply to Mrtroxely]

I had a double mastectomy in Costa Rica many years ago after bicalutimide gave me little titties. Women get breast reconstruction covered but man-boobs are not, USA surgeons wanted $15K for what was effectively a 30 min sedated procedure, my cost was $3k (2010 dollars) in a wonderful facility, including travel and some tourism.

[awb1]

I posted earlier on penile implants, and just found this current thread. This entire discussion was very informative, thanks for sharing guys. In my cases I've somewhat exhausted the pills, never like the injection, the pump is helpful but I soldier on. I've read so much about implant satisfaction and the idea that anytime for any length of time is compelling. I would like to hear comments on personal experience, bad, neutral, or good on prosthesis.

[Papillon2]

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