POSTED: October 22, 2015

Erectile Dysfunction + Prostate Cancer

In July’s Prostate Forum, we’re talking about erectile dysfunction, incontinence, and prostate cancer with Drs. Abraham Morgentaler, Peter Chang and Jean-Francois Eid.

Read these conversations.

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Here’s Dr. Myers’s introduction to the issue:

In this issue, we’re featuring conversations with three urologists who have elected to focus on erectile dysfunction and incontinence. Between them, these physicians have treated thousands of patients. I was gratified to see the extent to which each paints the same picture of the various treatment options available to you.

The bottom line is that both erectile dysfunction and incontinence are very common in men with prostate cancer. The good news is that more often than not, there is something your doctor can do about it. Suffering in silence is pointless. At the very least, talk to your doctor about what is going on.

I do have several points to add to the comments made below by our featured physicians, though. Viagra and medications like it are indeed quite effective. As you’ll see, each of the physicians we spoke with stresses the high cost of these medicines. Depending on the pharmacy, ten 100 mg

Viagra tablets or 20 mg Levitra tablets cost between $350-$400. Ten 20 mg Cialis tablets cost between $400-$450. Many insurance companies do not cover these drugs at all or will cover an inadequate number of pills. Many men who might benefit from these drugs simply cannot afford them.

There is an alternative. Revatio is a medication used to treat pulmonary arterial hypertension. It also contains sildenafil, the active ingredient in Viagra. Revatio is available in generic form as a 20 mg pill. When I did a cost analysis, I found that Sam’s Club and Walmart often charge under $60 for 90 pills. This works out to $0.67 per pill. Five Revatio tablets are equal to a single 100 mg Viagra tablet. Revatio costs $3.33 compared to about $40 for the 100 mg Viagra. While the generic sildenafil is chemically identical to Viagra, it is FDA-approved for pulmonary hypertension.

So, prescribing it for sexual function is considered off-label. However, in the United States, prescribing drugs off-label is allowed.

As each of the physicians we spoke with point out, the loss of sexual function from radiation develops slowly after radiation therapy and can take up to five years to fully manifest. It appears that radiation alters the blood vessels going to the penis in a way that results in a slow decay in the ability of the arteries to open up and increase blood flow. As Viagra and related drugs work by improving blood vessel relaxation, these drugs are often quite effective in treating sexual dysfunction after radiation.

There is also some evidence that daily low doses of these drugs are more effective than taking a single large dose at the time of sexual activity. They may even slow or prevent the slow progressive damage seen following radiation, especially if they’re started early. Again, until recently, cost has been a huge issue for many men. The availability of a generic sildenafil in the form of Revatio offers a solution.

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