Table of Contents

Chapter 3: Maximizing Quality of Life After Initial Treatment

i. Oral Medications

In 1998, a remarkable new medication came on the market. Known as sildenafil (Viagra), the drug was the first oral medication approved by the FDA to treat erectile dysfunction.When a man is sexually stimulated, sildenafil, along with two similar drugs released a few years later, tadalafil (Cialis) and vardenafil (Levitra), relaxes the muscles in the penis, allowing blood to rapidly flow in. As with a natural erection, tiny valves at the base of penis lock shut, preventing the blood from flowing back out and therefore causing the penis to stay rigid. On average, the drugs take about an hour to begin working; the erection-helping effects of sildenafil and vardenafil last for about 8 hours and tadalafil about 36 hours. About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs.

However, these drugs are not for everyone. Many men with angina or other heart problems take medications that contain nitrates to help the blood flow better to the heart. All three agents used for erectile dysfunction can affect the way that the nitrates work—and cause your blood pressure to drop to dangerously low levels. They can also interfere with alpha-blockers, drugs that are commonly used in men with the noncancerous growth of the prostate known as BPH, and that are often used in men following certain types of radiotherapy, particularly brachytherapy. It’s important therefore to make sure that all of your doctors know about any and all medications that you might be taking.

Interestingly, recent data have shown that the oral drugs for erectile dysfunction might have a role in speeding up the recovery process after primary therapy. As we noted earlier, even if the nerves are not irreparably damaged during surgery or radiation therapy, it can take up to a year for full erectile function to return. Nevertheless, many men have found that daily use of the oral drugs can help to "rehabilitate" their erectile function and return them to baseline function more quickly. Although this use has become rather common in many centers across the country, clinical studies are just now underway to determine the optimal usage and dosage, so be sure to discuss with your doctor whether this approach is right for you before attempting any sort of therapeutic use of these drugs on your own.

Finally, remember that these are not recreational drugs; they’re very serious medications. Don’t attempt to buy cheaper versions of the pills on the Internet that might or might not contain the medication that you need.