Question on Cialis and RT

[Mtnhigh]

My husband chose RT rather than "watchful waiting." Thank you Tall_Allen for the link to the MSK nomogram. Tall_Allen had mentioned that taking Cialis/Viagra (5mg) was protective of the penile artery. Today we asked the RO for the prescription but she didn't want to prescribe as she wasn't aware of any research that showed it was helpful. Do you know if there is research I can show her? Does anyone know of other sources online? I did find the research showing aerobic exercise reduced rectum toxicity during RT. You all provide such useful information....thank you!

[Hidden]

When I had my Prostatectomy, I asked my surgeon for Sildenafil. He asked why, I responded:

"Sildenafil is a medication that is prescribed for relaxing your blood vessels and lowering the blood pressure in your lungs. Allowing better blood flow. Generic for Revatio.

I would like that to open the blood vessels in the surgical area to promote healing and since your surgery was nerve sparring, allow more blood to the nerves.

He said it couldn't hurt!! And complied.

So, maybe you ask for Sildenafil, it is the equivalent to Viagra, but doesn't sound like you want it for an erection.

BTW, it works for that too!!!

[Mtnhigh in reply to Hidden]

Thank you. Good ideas!

[Ducttape in reply to Hidden]

Hi there folks! I decided on HDR and 25 rounds of EBRT and have been on Lupron a little before and now close to 2 years later. I had my Primary care Doc prescribe generic Cialis very early as my treatment started. After about 6+ month on Lupron, the Big Head and the Little Head bailed out from the side effects (unfortunately I was one of the group where Lupron slammed me). Cialis generic for me was a great help to allay the dang physical effects. Please find the Doc (MO or Primary) that will get on Cialis. the generic is fine and pretty inexpensive for the results. Play around with the dosage that will work - 40-80+ , who cares! as long as it gives you two a shot at intimacy. There is so much mentally that can get in the way --- let medicine rein. Party On, Ducttape

[Mtnhigh in reply to Ducttape]

Thanks to all we now have ammunition to send to Docs. We will keep at it until we get someone to prescribe. Finding out the mental side is a whole different ball game.

[Tall_Allen]

Send this to her:

auajournals.org/article/S00...

[Mtnhigh in reply to Tall_Allen]

Thank you, I will send it to her. The study mentions sildenafil citrate at 50mg. Would 50mg be considered a low dose? I know you and other folks have mentioned Cialis at 5mg as a low dose.

[Tall_Allen in reply to Mtnhigh]

It is an average dose. 20 mg Sildenafil is a low dose - the study was done before daily dosing. 5 mg tadalafil is also a daily dose. It is FDA-approved for Lower Urinary Tract Symptoms (LUTS).

The only reason to not use it is if you'd had a prostatectomy; It can increase incontinence. Since you had radiation, that is not a concern.

If used with an alpha-blocker, one has to be careful about getting up too quickly.

[Mtnhigh in reply to Tall_Allen]

Understand, thank you so much!

[MMMayhem in reply to Mtnhigh]

I can confirm Tall_Allen's input. Had RP, and discovered it was metastatic and then had to do the radiation and hormone therapy. My surgeon had me on sildenafil at 20mg daily and then a weekly "challenge" dose of 100mg. I did end up with a small amount of permanent incontinence. It's a minor inconvenience and I wear the lightest pad to help deal with it.

With your situation not including the surgery, the incontinence is likely less of an issue. However, regarding the sildenafil treatment, be sure to take the challenge part seriously. I did not. The situation and ADT reduced libido, etc. I ended up developing venous leakage from not getting or maintaining an erection during the treatment. The artery would supply the blood, but the vein wouldn't work to retain it. The use it or lose it axiom is not a joke or fallacy.

No ED treatments were effective including injections and I ended up getting a penile implant. It's got its pros and cons, but it's better than nothing. I highly recommend looking into the men's sexual health department at MSK run by Dr John Mulhall. He is a leading expert and definitely worth consulting with on the details of dealing with the sexual health effects of the cancer treatment like what doses of sildenafil are best, etc.

Good luck.

[Mtnhigh in reply to MMMayhem]

MM, Thank you for your detailed response including MSK info. I wasn't aware of the challenge dose. We will look into that.

[MMMayhem in reply to Mtnhigh]

It would have been better if I could have learned from my mistake BEFORE I made it. 😉

This forum was a ton of help to me when I was deciding on and going through my treatment. I try to share what I learned and my experiences to return the favor.

[dentaltwin in reply to Mtnhigh]

For what it's worth, after my RP my surgeon pretty much told me to get on sildenafil and wrote the prescription. I have no idea if it delayed my continence, but it returned almost completely at 3-4 months. They very much stressed the importance of "penile rehab". It did give me headaches, and as I had lost my wife and was not "out there" I didn't see the need.

More recently I entered another relationship; I was given an appointment to see a sexual health guy at MSK; I told him sildenafil gave me headaches, and he put me on tadalafil (5 mg. 6 days a week, and 25 mg on the 7th day). The headaches still occur, but not as frequently and not as severe as with the sildenafil. It is moderately effective at producing an erection. (Incidentally as my cardio tells me I'm starting to develop pulmonary hypertension, and this class of drug has an indication specifically for that, it may be helping me there too).

[Mtnhigh in reply to dentaltwin]

Thanks for mentioning possible headache issues. I just saw the research on Viagra reducing risk of heart and stroke issues. Husband had a stroke few years ago so an added benefit.

[treedown]

Ask your MO or GP its probably just that Dr. My MO said no problem.

[Mtnhigh in reply to treedown]

Good idea, thanks. He doesn't have an MO. So maybe we'll ask his urologist and see what happens.

[cesanon]

(a) Where are you geographically located?

(b) Trental works too together or alone

(c) You really need to get a medical oncologist... as a top priority

[Mtnhigh in reply to cesanon]

We are in Colorado Springs. I had not heard of Trental...good to know. I was wondering about an MO. The urologist diagnosed and recommended RT. We consulted 3 ROs. We consulted Mayo AZ but we decided to do local treatment. My husband was more comfortable staying home. We are not happy with the urologist and are looking to replace him. We are hoping that the RT therapy will take care of everything so didn't think about getting an MO yet. Now I am rethinking.

[cesces in reply to Mtnhigh]

You should not have any problem getting rental if you are getting radiation.

But have your primary care physician prescribe it so you use momentum to stay on it forever instead of just a few years.

It's just generally good for you. Both my RO and MO just permanently used it for themselves. Like metformin, it's just generally good for you.

[Mtnhigh in reply to cesces]

Thanks we will definitely pursue this!

[MMMayhem]

MSK has some great info and research in this area, especially as it relates to sexual health in conjunction with prostate cancer care.

mskcc.org/cancer-care/diagn...

[Scout4answers]

I get Cialis from my Urologist but you could also get it from your GP. Sexual function is not over with PCa.

We are 18 months into ADT and still having multiple encounters /week. Would be happy to elaborate via PM or phone if you two need help.

[Mtnhigh in reply to Scout4answers]

Scout, We've sent a message to the urologist asking for prescription. Hope to hear tomorrow. Provided link that Tall_Allen provided above. It looks like we could do telemedicine sites and pay double but would much rather have one of his Dr's prescribe.

[silver5]

You can find another extensive discussion of cialis et al on this forum last month healthunlocked.com/advanced...

As I wrote back then, In December, 2020, I happened to hear a talk on ““Incontinence and Sexual Side Effects of Prostate Cancer Treatment” by Salt Lake City Urologist & Men’s Sexual Health Physician Dr William Brant, who said daily Cialis was helping a number of his patients. Links to his talk and slides can be found at

Talk:gotostage.com/channel/586ae... and

Slides: naspcc.org/docs/Incontinenc...

Thanks to those links I was able to persuade my Kaiser urologist to prescribe 5mg daily Tadalafil (generic for Cialis) “for urinary problems.”

Since then, Tadalafil has helped my libido and even enabled me to keep an erection at least for a minute or two after manual stimulation from my wife so we can even enjoy senior sex every week or so – despite ADT. Great for my mood and our relationship.

[Mtnhigh in reply to silver5]

Such great info from everyone! Thank you all. If urologist won't prescribe I'll send all the links to everyone, uro, GP and MO. Think we are getting the run around. MO said not comfortable prescribing talk to uro about it. Don't think GP will. He has attitude that he referred due to high PSA so now uro takes care of everything in that area. This is just like the software industry (used to work in). Call the hardware manufacture...his problem, or call the 3rd party app...their problem. Didn't think medicine would be like this.

[Mtnhigh in reply to Mtnhigh]

Oops...meant RO above not MO. RO doesn't want to prescribe. We don't have an MO at this point.

[TEBozo]

Are you kidding me? I would furiously explain to your doctor that it should be up to the patient if he takes an ED drug!

[Mtnhigh in reply to TEBozo]

Yep agree. Waiting to see response from uro tomorrow.

[sharpcut]

This Chat Group has been so Valuable to me. Thank You All (esp Tall Allen)

Hope this Helps someone !

History - Nerve Sparing RP August 2018. Dr Eastham MSK Reoccurrence and Radiation Completed July 2020. Dr Mychalczak. MSK 40 treatments 72 c GY Undetectable Since ! Was taking 20 mg of Sildenafil as per Dr Mulhall for 1.5 Years. Sexual Function Restored over time with Weekly Injections as well

But was told incontinance could only be corrected by surgery. NOT TRUE. Amazing Physical Therapist helped with Pelvic Floor exercises. Very Easy if dedicated to doing the exercises daily for at least 4 weeks I am in Westchester NY. Physical Therapist is in Wappingers Falls. NY Kelcie Lewis a certified ReVital Cancer Rehabilitation Specialist, of Nuvance Health. Extremely Knowledgeable

Contact me if I can you need. to for any reason

[Mtnhigh in reply to sharpcut]

I so agree about the value of this group! My husband can't bring himself to research his own health issues so I gladly do it. Now if any questions or concerns come up he says "ask the people on the blog." We have found better suggestions and research here than asking the drs. Thank you for your kind offer.

[Anesthesia966]

hav have your gp write for it, use mark Cubans cost plus drugs pharmacy cheap

[Mtnhigh in reply to Anesthesia966]

Thanks, I wasn't aware of mark Cubans cost plus. Will use it.

[EdinBmore]

I'll add my 2 cents for whatever it's worth. One of the first questions I was asked during initial interviews with uro, RO, and medical oncologist was, "are you interested in ED meds?" It certainly is interesting how SOC can vary across the country and that some docs seem to be oblivious about the importance of one's sex life and their role in supporting it. I was given a couple of options and chose daily Cialis, 5mg. Later, I joined a study which provided info, videos, sex "aids" (e.g., "cock rings") and sildenafil. The study recommended it 3 times/wk, 60mg each dose. The study also recommended using a penis pump (provided as well). I was taking Lupron at the time and had zero interest in all things sexual; however, I scheduled myself into a routine of taking the meds and using the "equipment." I am very glad that I did. I think their use lessened genital atrophy and helped in my being able to get an erection. And, to echo others, Tall_Allen is an excellent source of information. Good luck to you.

EdinBaltimore

[Mtnhigh in reply to EdinBmore]

Thanks Ed. My husband wasn't aware that he needed the meds for radiation. So glad tall_Allen previously mentioned that helps during and after RT. Now just need to figure out how to get Dr to prescribe. Uro hasn't responded yet to request.