What are the treatment options for erectile dysfunction in patients with Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

For treating erectile dysfunction (ED) with benign prostatic hyperplasia (BPH), 5mg daily tadalafil should be discussed as a treatment option, as it can effectively address both conditions simultaneously, improving urinary symptoms while treating ED. This recommendation is based on the most recent and highest quality study, which suggests that tadalafil is a reasonable option to trial in selected men, ideally those with concomitant erectile dysfunction 1. The mechanism of action of tadalafil's effect on lower urinary tract symptoms (LUTS) is only partially understood, but it has been shown to result in little to no difference in International Prostate Symptom Score (IPSS) as compared to placebo, while probably increasing response to the IPSS compared to placebo.

Key Points to Consider

• Tadalafil 5mg daily is a recommended treatment option for patients with LUTS/BPH, irrespective of comorbid ED, due to its ability to improve urinary symptoms while treating ED 1.
• The combination of low-dose daily 5mg tadalafil with alpha blockers for the treatment of LUTS/BPH is not recommended, as it offers no advantages in symptom improvement over either agent alone 1.
• Other options, such as combination therapy with an alpha-blocker plus on-demand PDE5 inhibitors, may be considered, but patients should be cautious of potential interactions and side effects.
• Regular follow-up appointments are necessary to monitor effectiveness and adjust treatment as needed.

Treatment Options

• Tadalafil 5mg daily: a recommended treatment option for patients with LUTS/BPH and comorbid ED.
• Combination therapy: may be considered, but patients should be cautious of potential interactions and side effects.
• Alpha-blockers: may be used in combination with 5-ARI or other medications, but the combination with low-dose daily 5mg tadalafil is not recommended.

From the FDA Drug Label

Tadalafil tablets are a prescription medicine taken by mouth for the treatment of: men with erectile dysfunction (ED) men with symptoms of benign prostatic hyperplasia (BPH) men with both ED and BPH Tadalafil tablets for the Treatment of ED and Symptoms of BPH ED and symptoms of BPH may happen in the same person and at the same time. Men who have both ED and symptoms of BPH may take tadalafil tablets for the treatment of both conditions. Tadalafil tablets are indicated for the treatment of ED and the signs and symptoms of BPH (ED/BPH). Tadalafil can be used to treat erectile dysfunction with BPH. The medication is indicated for the treatment of both conditions, and men with both ED and BPH may take tadalafil tablets for the treatment of both conditions 2 2. Key points to consider:

• Tadalafil tablets are a prescription medicine taken by mouth for the treatment of men with ED, BPH, or both.
• Men with both ED and symptoms of BPH may take tadalafil tablets for the treatment of both conditions.
• The medication is indicated for the treatment of ED and the signs and symptoms of BPH (ED/BPH) 2.

From the Research

Treating Erectile Dysfunction with BPH

• Erectile dysfunction (ED) is a common male sexual dysfunction associated with a reduced quality of life for patients and their partners, and is often linked with benign prostatic hyperplasia (BPH) 3.
• The evaluation of men with ED requires a full medical and personally and culturally sensitive sexual history, a focused clinical examination, and various tests, including fasting glucose levels and a prostate-specific antigen test 3.
• Treatment of ED requires lifestyle modification, reduction of comorbid vascular risk factors, and treatment of organic or psychosexual dysfunction with either pharmacotherapy alone or in combination with psychosexual therapy 3.

Phosphodiesterase-5 Inhibitors for ED and BPH

• Phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil, tadalafil, and vardenafil, are commonly used to treat ED and have been shown to improve lower urinary tract symptoms (LUTS) in men with BPH 4, 5, 6, 7.
• PDE-5 inhibitors can increase intracellular concentrations of cyclic guanosine monophosphate, regulating smooth muscle tone in the human prostate and improving LUTS 6.
• Combination therapy using PDE-5 inhibitors and alpha1-adrenergic blockers may have an additive beneficial effect on BPH/LUTS compared with monotherapy 6, 7.

Efficacy of PDE-5 Inhibitors for ED and BPH

• Studies have shown that PDE-5 inhibitors can significantly improve LUTS and erectile function in men with BPH, with or without ED 5, 7.
• A systematic review and meta-analysis found that PDE-5 inhibitors alone or in combination with alpha1-adrenergic blockers can improve International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) scores, but may not significantly improve maximum flow rate (Q(max)) 7.
• The use of PDE-5 inhibitors for BPH/LUTS treatment is a promising option, but further studies are needed to elicit the exact mechanism of action and to confirm the safety, efficacy, and cost-effectiveness of PDE-5 inhibitors in the treatment of LUTS secondary to BPH 6, 7.