Prostate Medication

Cialis treatment for BPH

Benign prostatic hyperplasia is also known as BPH. It is currently one of the most common health conditions among older men.

The majority of us know it is all about having urinary problems. It is also the reason why the rectal examination might be imminent at some point in our lifetime.

However, there’s much more to know about this widespread condition. Modern medicine discovered that medications formerly used for erectile dysfunction might also work for BPH symptoms.

As you will see in this article, this is good news and an appropriate option for many patients with BPH.

So, is it possible to solve your erection problems and your urinary symptoms at the same time?

Let’s see what the medical evidence has to say. We will also review other options available to treat symptoms of BPH.

What is BPH?

The term benign prostatic hyperplasia (BPH) is commonly used to address benign enlargement of the prostate. Such a change in size typically causes a series of symptoms associated with the urinary tract.

However, if we dig a bit into terms, we will realize hyperplasia is a type of histological growth. Thus, the term BPH is a histological diagnosis. If we are not performing any biopsy, we can use the term “benign prostatic enlargement.” The latter describes the disease clinically. Not according to biopsy data, we have not yet confirmed (1).

Regardless of the term, we choose to use, BPH is caused by an adenoma (not the same as adenocarcinoma) of the prostate. It changes the configuration of the prostate and causes bladder outlet obstruction.

When it is severe, this obstruction may ultimately affect the bladder and the kidneys. The level of obstruction is variable.

It does not depend on the size of the prostate but the location of the adenoma or adenomata. Thus, we can find patients with a large and highly distorted prostate and no major symptoms. But another patient may have a smaller prostate and more concerning symptoms (2).

Signs and Symptoms of BPH

As we mentioned above, symptoms of BPH are caused by bladder outlet obstruction and retention of urine. They do not depend on the size of the prostate as much as they rely on the site of the alteration.

For example, a small growth at the bladder neck may cause more severe symptoms than a larger growth in the lateral lobes of the prostate (3).

The most common signs and symptoms are also known as lower urinary tract symptoms or LUTS. They are further divided into storage, voiding, and post-micturition symptoms (4).

Storage symptoms of BPH include:

Voiding symptoms of BPH include:

  • Difficulty to start urinating

  • An intermittent urine flow

  • Feeling the urge of straining, forcing or pushing to finish urinating

  • Terminal dribble (continuous drops of urine after the mainstream)

Post-micturition symptoms of BPH include:

  • A sensation of incomplete emptying of the bladder

  • Post-micturition dribble (involuntary loss of urine, often staining the patient’s underwear, after he has finished passing urine)

Since BPH is a slow-progressing condition, patients get used to them, may not have complaints, and become asymptomatic. However, these patients may have an acute case of urinary retention. They may even have blood in the urine, renal failure, and other complications.

Thus, we can say that BPH causes a varying degree of obstruction of the urinary tract. According to each case, patients may or may not display significant symptoms (5).

How Cialis works for BPH

It is not rare to find cases of benign prostatic hyperplasia and erectile dysfunction in the same patient. It is a prevalent association. Not because BPH causes erectile dysfunction.

The exact cause of their association is not known. However, they are both conditions that become more prevalent in aging men (6).

Cialis, also known as tadalafil, is a drug typically used to treat erectile dysfunction. It works with an enzyme called phosphodiesterase (PDE). This enzyme contributes to the signalization inside the cell.

It works with molecules called cAMP and cGMP. Tadalafil (Cialis) inhibits a subtype of phosphodiesterase called PDE5, which interacts with cGMP.

This enzyme can be found in the smooth muscle of the corpus cavernosum of the penis and the blood vessels. It is also found in visceral smooth muscle, including the prostate, the urethra, and the bladder (7).

In simple words, what Cialis does is causing relaxation of the smooth muscle. However, it is important to note that while Cialis alleviates symptoms, it in no way shrinks the prostate.

Cialis enters the organism, inhibits PDE5, and both nitric oxide and cGMP levels go up. As a result, the patient will achieve better erections and improve their LUTS at the same time (7, 8).

Is it an effective treatment?

It sounds very good in theory. But is Cialis effective in the medical practice to improve the symptoms of patients with BHP?

They do, according to four different randomized, double-blind, placebo-controlled trials (9, 10, 11, 12). These studies used tadalafil only once a day in men with LUTS diagnosed BPH. Additionally, one of these trials was performed in men with existing BPH and erectile dysfunction.

The clinical trials showed that using tadalafil once a day results in significant improvements in BPH symptoms in men.

The clinical trial lasted 12 weeks, and patients under 5 mg pills of Cialis had improved their quality of life compared to placebo patients. It was also noted that the improvements did not go any further by using a higher dose.

BPH symptoms started to improve after the first week of treatment in one trial (10). In another, it took 2 weeks of treatment to start seeing a significant difference (12). This improvement was maintained after one year of medical follow-ups.

Side effects

According to the clinical evidence, tadalafil may have the following side effects. In order of frequency, they are as follows:

  • Headache

  • Flushing

  • Dyspepsia

  • Back pain and myalgia

  • Nasopharyngitis

  • Diarrhea

  • Dizziness

The majority of these adverse reactions were found in a small proportion of patients (1-2%). 90% of them were reported to be of mild or moderate intensity.

4% of patients discontinued the treatment of tadalafil due to the presence of adverse events. This discontinuation rate was reduced to 2.9% in patients who had both lower urinary tract symptoms and erectile dysfunction (13).

There were no relevant changes in PSA levels, no events of urinary retention, and no increases in the post-void residual volume (13).

Natural alternatives for BPH

There’s still another alternative in natural solutions with no adverse effects. They are herbal medicines and natural remedies that will soothe your symptoms.

We can list the following as an example:

  • Boron: There is much evidence about boron as a suitable alternative to improve prostate health. It has been found to reduce the incidence of prostate cancer, too. This is a trace mineral, and we only need small amounts. But covering our daily requirements may significantly improve PSA levels naturally. It will also reduce in half the risk of cancer. This trace mineral can be found in foods but in a very small proportion. Thus, it is recommended to find a supplement that makes a real difference. It is a form of dietary prevention of BPH progression to prostate cancer (14).

  • Zinc: The daily recommendation of zinc is 90 mg. This mineral has also been proven useful to treat BPH. Diagnosed Not only BPH but also undiagnosed enlargement and inflammation of the gland. In vitro tests suggest that zinc induces apoptosis in human prostate cells. This may explain why it is useful to reduce urinary symptoms in cases of benign prostatic hyperplasia (15).

  • Ellagic acid: This is a natural antioxidant you can find in many different foods. It is especially abundant in berries. Ellagic acid triggers apoptosis in cancer cells. While doing so, it does not affect normal cells. Thus, it is an alternative to prevent the progression and spread of prostate problems (16).

  • Stinging Nettle: It is a plant of the nettle family. It is typically found in North America, Europe, North Africa, and Asia. Stinging nettle has been used as a herbal medicine for millennia to treat joint pain, back pain, and prostate problems. It also improves urinary symptoms in patients with BPH. According to data, it may even reduce the residual urine volume in these patients (17).

  • Turmeric: It is a popular spice in Asia with powerful anti-inflammatory and antibacterial potential. It has proven to be useful in many different ailments, including BPH. Turmeric controls and reduces the inflammation of the prostate and other tissues. Since inflammation is the cornerstone of cancer, it also prevents prostate cancer and slows down its progression (18).

  • Saw Palmetto: It is a type of palm typically found in North American countries. Saw Palmetto used as a supplement for prostate problems and to balance our hormone levels. This plant contains a type of flavonoids, substances that protect the plants. Flavonoids work along with essential fatty acids and other substances to reduce inflammation. That is how it improves lower urinary tract symptoms in men (17, 19).

Conclusion

Benign prostate hypertrophy is a common problem as we age. It is typically associated with additional health problems, especially in men’s erectile function.

Sexual problems may also be a side effect of certain medicines and medical procedures to treat BPH and prostate cancer. That includes tamsulosin (Flomax) and other pills. So, patients may feel inclined to neglect their symptoms to avoid side effects.

Recent studies have shown that Cialis, a medication formerly used for cases of erectile dysfunction, may also improve urinary symptoms in BPH.

It does so by relaxing the smooth muscle of the urinary tract and improving the blood flow.

However, it is important to bear in mind that while it helps to relieve symptoms, it does not treat the root of the problem and can have side effects.

Among natural treatments for this condition, we can count minerals such as zinc and boron. There are also flavonoids found in berries and stinging nettle.

Sources

  1. Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., … & Wein, A. (2003). The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology, 61(1), 37-49.
  2. Foo, K. T. (2016). Solving the benign prostatic hyperplasia puzzle. Asian journal of urology, 3(1), 6.
  3. Luo, G. C., Foo, K. T., Kuo, T., & Tan, G. (2013). Diagnosis of prostate adenoma and the relationship between the site of prostate adenoma and bladder outlet obstruction. Singapore Med J, 54(9), 482-486.
  4. Lepor, H. (2005). Pathophysiology of lower urinary tract symptoms in the aging male population. Reviews in urology, 7(Suppl 7), S3.
  5. Foo, K. T. (2019). What is a disease? What is the disease clinical benign prostatic hyperplasia (BPH)?. World journal of urology, 1-4.
  6. Seftel, A. D., De la Rosette, J., Birt, J., Porter, V., Zarotsky, V., & Viktrup, L. (2013). Coexisting lower urinary tract symptoms and erectile dysfunction: a systematic review of epidemiological data. International journal of clinical practice, 67(1), 32-45.
  7. Ückert, S., Küthe, A., Jonas, U. D. O., & Stief, C. G. (2001). Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. The Journal of urology, 166(6), 2484-2490.
  8. Kedia, G. T., Ückert, S., Jonas, U., Kuczyk, M. A., & Burchardt, M. (2008). The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms. World journal of urology, 26(6), 603-609.
  9. Roehrborn, C. G., McVary, K. T., Elion-Mboussa, A., & Viktrup, L. (2008). Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. The Journal of urology, 180(4), 1228-1234.
  10. Oelke, M., Giuliano, F., Mirone, V., Xu, L., Cox, D., & Viktrup, L. (2012). Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. European urology, 61(5), 917-925.
  11. Porst, H., Kim, E. D., Casabé, A. R., Mirone, V., Secrest, R. J., Xu, L., … & LVHJ Study Team. (2011). Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial. European urology, 60(5), 1105-1113.
  12. Egerdie, R. B., Auerbach, S., Roehrborn, C. G., Costa, P., Garza, M. S., Esler, A. L., … & Secrest, R. J. (2012). Tadalafil 2.5 or 5 mg administered once daily for 12 weeks in men with both erectile dysfunction and signs and symptoms of benign prostatic hyperplasia: Results of a randomized, placebo‐controlled, double‐blind study. The journal of sexual medicine, 9(1), 271-281.
  13. Carson, C. C., Rosenberg, M., Kissel, J., & Wong, D. G. (2014). Tadalafil–a therapeutic option in the management of BPH‐LUTS. International journal of clinical practice, 68(1), 94-103.
  14. Cui, Y., Winton, M. I., Zhang, Z. F., Rainey, C., Marshall, J., De Kernion, J. B., & Eckhert, C. D. (2004). Dietary boron intake and prostate cancer risk. Oncology reports, 11(4), 887-892.
  15. Feng, P., Li, T. L., Guan, Z. X., Franklin, R. B., & Costello, L. C. (2002). Direct effect of zinc on mitochondrial apoptogenesis in prostate cells. The Prostate, 52(4), 311-318.
  16. Bell, C., & Hawthorne, S. (2008). Ellagic acid, pomegranate and prostate cancer—a mini review. Journal of Pharmacy and Pharmacology, 60(2), 139-144.
  17. Koch, E. (2001). Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Planta Medica, 67(06), 489-500.
  18. James, M. I., Iwuji, C., Irving, G., Karmokar, A., Higgins, J. A., Griffin-Teal, N., … & Morgan, B. (2015). Curcumin inhibits cancer stem cell phenotypes in ex vivo models of colorectal liver metastases, and is clinically safe and tolerable in combination with FOLFOX chemotherapy. Cancer letters, 364(2), 135-141.
  19. Barry, M. J., Meleth, S., Lee, J. Y., Kreder, K. J., Avins, A. L., Nickel, J. C., … & McCullough, A. (2011). Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. Jama, 306(12), 1344-1351.

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