The Medicine Cabinet: Ask the Harvard Experts
By Howard LeWine, M.D.
Q: I recently saw my doctor for urinary symptoms. He said that I have enlarged prostate. We decided to wait to start treatment. But now I wonder if I should take Cialis since the TV ads say it helps with symptoms from an enlarged prostate and erectile dysfunction. Any suggestions?
A: Difficulties with urination become more and more common in men over age 50. Often the cause is the noncancerous enlargement of the prostate gland — benign prostatic hyperplasia, or BPH.
As the prostate puts pressure on the urinary plumbing, men experience symptoms such as difficulty starting urination, straining to empty the bladder, and having to get up frequently at night to urinate. Some men try to live with it, but at some point they may feel the need to explore medical solutions.
BPH’s frequent fellow traveler is erectile dysfunction (ED). A fair number of men develop both ED and symptoms of BPH. And it sounds appealing to take one pill that might help both.
Since you and your doctor decided to wait before starting medication for the BPH symptoms, perhaps the more important issue for you is ED. If that is the case, I would suggest contacting your doctor to focus on this issue.
Daily tadalafil (Cialis) is the only drug currently FDA-approved for use in men with both ED and BPH. If you did desire medication for ED, you may not need or want to take a pill every day. Most often men use an ED drug on as needed basis. Examples include a stronger dose of tadalafil and several similar drugs, such as sildenafil (Viagra), vardenafil (Levitra) and avanafil (Stendra).
If later you decide it’s time for medication to help with BPH symptoms, there are two types of drugs that doctors prescribe. Alpha blockers — such as alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (Hytrin) — relax the smooth muscles in the bladder neck and prostate. This improves urine flow and leads to less frequent need to urinate.
If the prostate is enlarged, the doctor may add a 5-alpha-reductase inhibitor, such as dutasteride (Avodart) or finasteride (Proscar). These drugs can help to shrink the swollen gland and take pressure off the bladder neck.
For men with ED and mild to moderate BPH symptoms who are willing to take a pill every day, tadalafil for daily use is certainly option.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)