From the Guidelines
Cialis (tadalafil) is not absolutely contraindicated in patients with a history of prostate cancer, but its use should be approached with caution and careful evaluation by a urologist and oncologist. The primary concern is that PDE5 inhibitors like Cialis may potentially stimulate cancer cell growth or recurrence in patients with a history of hormone-sensitive prostate cancer, although this is still a topic of debate 1. According to the American Cancer Society Prostate Cancer Survivorship Care Guidelines, men who experience ED after prostate cancer treatment may have never tried medications or devices to improve their erections, and early penile rehabilitation after prostate cancer surgery may improve sexual function outcomes and prevent end-organ penile damage due to neurovascular injury and fibrosis 1.
For patients with treated, stable prostate cancer who have been in remission for a significant period, the use of Cialis should only be considered after thorough evaluation by both a urologist and oncologist. The decision should be individualized based on the patient's cancer status, treatment history, time since treatment, PSA levels, and overall health. Some key factors to consider include:
- The type of prostate cancer treatment the patient received, such as radical prostatectomy or radiation therapy
- The patient's current PSA levels and overall health status
- The presence of any comorbidities, such as vascular disease or diabetes mellitus
- The patient's baseline erectile function and any previous treatments for ED
Alternative treatments for erectile dysfunction in these patients might include:
- Vacuum erection devices
- Penile injections
- Penile implants
- Combination therapy, such as sildenafil and vacuum constriction, which may improve erectile function, although this should be managed in collaboration with a urologist or sexual health specialist 1. Any patient with a history of prostate cancer who is considering Cialis should have regular PSA monitoring and follow-up evaluations to ensure there are no signs of cancer recurrence or progression.
From the FDA Drug Label
Efficacy Results in ED Patients following Radical Prostatectomy — Tadalafil was shown to be effective in treating patients who developed ED following bilateral nerve-sparing radical prostatectomy In 1 randomized, placebo-controlled, double-blinded, parallel-arm design prospective trial in this population (N=303), tadalafil demonstrated clinically meaningful and statistically significant improvement in erectile function, as measured by the EF domain of the IIEF questionnaire and Questions 2 and 3 of the SEP diary
There is no direct contr indication for Cialis (tadalafil) in patients with previous prostate cancer. In fact, tadalafil was shown to be effective in treating patients who developed ED following bilateral nerve-sparing radical prostatectomy 2.
From the Research
Counter Indications for Cialis in Patients with Previous Prostate Cancer
- There is no direct evidence to suggest that Cialis is contraindicated in patients with previous prostate cancer 3, 4, 5, 6.
- However, patients with previous prostate cancer may experience erectile dysfunction (ED) due to the treatment they received, such as radical prostatectomy or radiation therapy 3, 4, 5, 6.
- In such cases, Cialis (a phosphodiesterase type 5 inhibitor) may be used as part of a penile rehabilitation program to help patients regain erectile function 3, 4, 5, 6.
- Alternative therapies, such as vacuum erection devices (VEDs), intracavernosal injections, and penile implants, may also be considered for patients who do not respond to oral therapy 3, 4, 5, 6.
- It is essential to note that the use of Cialis or other ED treatments should be discussed with a healthcare provider, as they can help determine the best course of treatment for each individual patient 3, 4, 5, 6.
Considerations for Patients with Previous Prostate Cancer
- Patients with previous prostate cancer should be aware of the potential risks and benefits of using Cialis or other ED treatments 3, 4, 5, 6.
- Regular follow-up appointments with a healthcare provider can help monitor the patient's condition and adjust the treatment plan as needed 3, 4, 5, 6.
- Additionally, lifestyle modifications, such as exercise, may also be beneficial for patients with previous prostate cancer, as they can help improve overall health and reduce the risk of cancer recurrence 7.