After Prostate Cancer Treatment, What Should I Take: Viagra, Levitra, Or Cialis?

   November 16, 2012   

David Samadi, MD, world-renowned robotic prostate cancer surgeon, recommends erectile dysfunction (ED) medication to men during prostate cancer recovery.

A variety of medical conditions and treatments can contribute to erectile dysfunction (ED). After robotic prostate surgery, it is common for men to experience short-term sexual potency issues. Dr. David Samadi’s SMART (Samadi Modified Advanced Robotic Technique) robotic surgery greatly reduces the risk of nerve bundle damage and delivers superior prostate cancer treatment results.

To facilitate sex after prostate cancer and speed the restoration of natural erections, Dr. Samadi often recommends PDE-5 (phosphodiesterase) inhibitors such as Viagra, Levitra, and Cialis, as a first-line treatment for erectile dysfunction (ED). Among these three commercially available PDEIs, analysis shows comparable efficacy. Randomized, controlled studies have shown small, but not statistically or clinically significant differences exist among the three drugs.

Q:  What are the differences among Viagra, Levitra, and Cialis?

A:  These drugs all belong to a class of medication known as phosphodiesterase inhibitors (PDEIs) and work by the same mechanism. Choosing one drug over the other depends on their onset of action, duration, contraindications, and other individualized preferences. However, because they are similar, if you are unable to see results with one, it is unlikely that another in the same class would work.

Q:  What are the side effects of PEIs?

A:  As with all drugs, there are side effects when using PDEIs. Deciding which one is more tolerable is a matter of choice. Examples of reported side effects include back pain with Cialis and light sensitivity with Viagra.

Q: How will my doctor determine which ED medication is right for me?

A:  Although PDEIs have similar efficacy, your urologist will consider several factors when recommending ED medication: 1) your preference for or perceptions about a particular PDEI, 2) cost of the treatment, 3) the duration of action or how long the erection is likely to last, 4) your desired frequency for sexual intercourse, and 5) the unique adverse-effect profile.

Viagra Levitra Cialis

Following are overviews of these three commonly used ED medications:

Viagra Usage (Sildenafil)

Onset of action: 30 minutes
Duration of action: 4-6 hours (on average 4 hours)
Consuming meals high in fat may hinder speed of action
Initial recommended dose: 50 mg
Recommended dose in patients over 65: 25 mg
Side effects may include: headache, flushing, sensitivity to light, upset stomach, runny nose, or abnormal vision

Levitra Usage (Vardenafil)

Onset of action: 30 minutes
Duration of action: 4-6 hours (on average 5 hours, typically longer than Viagra)
Consuming meals high in fat may hinder speed of action
Initial recommended dose: 10mg
Recommended dose in patients over 65:  5mg

Cialis Usage (Tadalafil)

Onset of action: 30 minutes to 2 hours
Duration of action: 36 hours (longest of the three PDEIs)
NOT affected by consuming fatty foods
Initial recommended dose: 10 mg
Recommended dose in patients over 65: 10 mg
Side effects may include: headache, upset stomach, back pain, or runny nose

Patients who have ED secondary to radical prostatectomy, diabetes mellitus, or severe peripheral vascular, have a lower response rate than those with no comorbidities. Diseases that contribute to injury or compromise of the blood supply or innveration to the corpus cavernosa may be responsible for the lack of success in patients who suffer from them. Dosing will vary in patients with kidney failure, liver failure, or other medical conditions.

Dr. David Samadi is Vice Chairman, Department of Urology and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York where he has performed more than 4,000 successful SMART robotic prostatectomy procedures. Within just a year or two after surgery, 85 percent of his patients regain sexual potency.

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