Does Cialis Affect PSA Levels?
No, tadalafil (Cialis) does not significantly affect PSA levels and should not interfere with prostate cancer screening or monitoring. The available evidence does not demonstrate any clinically meaningful impact of tadalafil on PSA measurements.
Key Clinical Evidence
The research and guideline literature addressing tadalafil's effects on various prostate-related outcomes, including studies specifically examining men with BPH and erectile dysfunction, does not report any significant alterations in PSA levels with tadalafil use 1, 2, 3. Studies evaluating tadalafil in men with both ED and BPH symptoms tracked PSA as a baseline characteristic and safety parameter without identifying PSA changes as a treatment effect 1, 3.
Important Distinctions from 5-Alpha Reductase Inhibitors
This is critically different from 5-alpha reductase inhibitors (5-ARIs) like finasteride and dutasteride, which DO significantly affect PSA levels. 5-ARIs reduce PSA by approximately 50% after 6-12 months of treatment, requiring clinicians to double the measured PSA value to interpret results accurately 4. Tadalafil does not share this mechanism and does not require PSA adjustment.
Practical Clinical Implications
- Continue routine PSA screening according to standard guidelines in men taking tadalafil without any adjustment to the measured value 4
- PSA testing should still be offered annually to men over 50 with >10 year life expectancy who are on tadalafil, as the medication does not interfere with cancer detection 4
- Baseline PSA measurements were tracked in major tadalafil trials as safety parameters, and no clinically significant changes were reported across studies enrolling over 1,000 men 1, 2, 3
- When tadalafil is used for BPH symptoms (5 mg daily dosing), PSA monitoring remains unchanged from standard BPH management protocols 5, 6
Clinical Context for Men with BPH
In men with BPH taking tadalafil 5 mg daily (FDA-approved for both ED and BPH), approximately 25% may have PSA >4 ng/mL due to the BPH itself, not the medication 6. The elevated PSA reflects prostatic enlargement and should be evaluated according to standard protocols, as tadalafil does not mask or artificially lower these values 4, 6.
Common Pitfall to Avoid
Do not confuse tadalafil with 5-ARIs when counseling patients about PSA testing. Unlike finasteride or dutasteride, tadalafil does not require any mathematical adjustment or special interpretation of PSA results 4, 5.