Cialis duration after SBRT

[Mike404]

I was prescribed Cialis as a possible protectant for radiation damage to blood vessels. I had a five session SBRT. A year out, I have few if any side effects. No erectile issues, but I’ve stayed on the Cialis on the assumption it might reduce future radiation damage.

My research indicated ED started years after radiation as blood vessels became degraded. If that’s so, it seems like the prophylactic dosing of Cialis might help, and probably doesn’t hurt. I’ve also stayed on tamsulosin, as I have a stronger stream with it.

Any research on optimal duration for Cialis? Any thought?

[Tall_Allen]

I stayed on daily Viagra (20mg) for about 9 months. I never had a problem. The goal is to avoid scar tissue in the penile arteries by protecting the walls of the blood vessels with nitric oxide. I probably didn't have to use it that long, but there was no downside and lots of upside.

[Whitby2]

I don't have any experience with tamsulosin after radiation. I was initially taking it for BPH with an increasing PSA & low level disease. Was on active surveillance. Then told to take it prior to a transperineum biopsy when PSA jumped. Gleason 4+3 result with ECE. My journey is about to start.

[BanjoPicker]

I was on 2/day tamsulosin before 43 IMRT hits. After the radiation my Urologist told me to take 1/day in the AM and take 1/day 5mg Cialis in the evening. Thirteen months post radiation I had a TURP proceedure. Told to continue tamsulosin for 1 month post surgery and continue on the one-a-day Cialis. I haven’t been told of an end date for the Cialis.

[JWS13 in reply to BanjoPicker]

do you still get erections? did the cialis work?

[BanjoPicker in reply to JWS13]

The Eligard shot I had before I started radiation caused me to have no erections and a general feeling that I would never be active again. Once I started daily Cialis, and the Eligard was out of my system, I began having normal morning erections. The purpose of daily Cialis is to improve blood flow to the area. Short answer…It works.

[Mike404]

Never had erection issues. Toward the end of ADT I had to force the interest, but no real problems. The Cialis was to prevent arterial degradation from radiation. I just have no idea how long to take it for that. It certainly doesn’t hurt the erections, so I’m staying in it for a while.

[Seasid]

The optimal duration for using Cialis (tadalafil) after stereotactic body radiation therapy (SBRT) for prostate cancer is not definitively established, but here's a synthesized summary of the evidence and considerations:

### **Key Evidence & Guidelines:**

1. **Short-Term Use (6–12 Months):**

- Studies (e.g., Zelefsky et al., 2013) suggest daily tadalafil for **6–12 months** post-radiation may improve erectile function preservation, likely by enhancing blood flow and endothelial protection during the critical recovery phase.

- AUA guidelines endorse early PDE5 inhibitor use post-treatment but do not specify exact duration. Many clinicians recommend at least **6–12 months** based on trial data.

2. **Long-Term Use Beyond 1 Year:**

- Limited evidence exists for benefits beyond 1 year. Radiation-induced vascular damage progresses slowly, so theoretical rationale exists for continued use, but human studies are lacking.

- Risks of long-term use (e.g., headaches, hypotension, cost) are generally low but should be weighed against unproven benefits.

### **Practical Considerations:**

- **Current Status:** You’ve completed 1 year without erectile dysfunction (ED), which is a positive prognostic sign. Continuing Cialis could be reasonable if tolerated, but stopping to assess function is also an option.

- **Tamsulosin Combination:** PDE5 inhibitors + alpha-blockers (like tamsulosin) may rarely cause hypotension, but your tolerance so far suggests safety. Continue monitoring if staying on both.

### **Recommendations:**

1. **Shared Decision-Making:** Discuss with your urologist/oncologist:

- Trial off Cialis to evaluate baseline function.

- If discontinuing, monitor for ED and restart if needed.

- If continuing, periodic reassessment (e.g., every 6–12 months) is prudent.

2. **Lifestyle/Alternatives:** Focus on cardiovascular health (exercise, diet, smoking cessation) to support vascular integrity, as this may mitigate late radiation effects.

### **Bottom Line:**

While 6–12 months of prophylactic Cialis is evidence-based, extending use is a personalized choice. Your current regimen appears safe, but ongoing dialogue with your care team ensures alignment with the latest evidence and your preferences.

DeepSeek said