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Tadalafil benefits before Radiotherapy

User
Posted 27 May 2026 at 08:24

Has anyone been advised taking a daily 5mg Tadalafil is beneficial during Radiotherapy? There seems inconclusive evidence that it might be . I think quite a few people are prescribed it already anyway. Husband is currently on Hormone Therapy and GP has upped his Sildenafil to 100mg . 50mg was working OK but he now has the choice to break it in half if he wants to. GPs suggestion. 

I just have a thought the 5mg daily may be more protective to prevent tissue damage.

Husband is getting on fine with the vacuum pump. He uses it about every other day just before a shower. 

If anyone is taking the 5mg Tadalafil how are you finding it? Did you ask for it or was it prescribed? I'm not thinking particularly about the efficacy for intercourse, more for keeping the blood flow going 

Edited by member 27 May 2026 at 23:16  | Reason: Not specified

User
Posted 28 May 2026 at 09:44

Fingers crossed your husband’s treatment will go smoothly. Happy to share my experience of this awful condition! Best of luck with it all, to you all. 🙏🏾

User
Posted 28 May 2026 at 13:33

Hi Antoinette,

I started taking 5mg just prior to my HT. I'd bought them online from Pharmica. I think it helps. I was then prescribed 4 x 20mg every 3 weeks along with the pump after my ED clinic meeting.

I've continued to topped up online and tend to take 10mg every other day. If you do buy extra online, I opted to get 20mg tablets as it cheaper, they can be broken into 4 if you wish, they even come with easy break lines, I just half them though.

I think it's Bicalutamide that can cause breast tenderness/growth after a while, it works differently to Zoladex / Prostap. I've not suffered with either.

All the best

John

User
Posted 28 May 2026 at 18:25
I was on 3 yrs Zoladex, starting 2015 aged 59, with 32 sessions of RT to prostate/pelvis to treat T3b, G 8 (upped to 9 after TURP), 2 yrs abiraterone,enzalutimide,prednisolone included on trial.

No Tadalafil etc mentioned or other 'additional' aids. Times change and this was 10 years ago. Things work as they should, no complaints. Maybe if I started treatment aged 70 or so it may have been different?

Peter

User
Posted 28 May 2026 at 20:10

After I'd been diagnosed and put on to hormone therapy, I started reading about it and that Tadalafil could be useful to try and preserve erectile function and prevent long term damage to penile tissue while you have no Testosterone. At the same time, my GP asked me in for an appointment (Cancer Care Review 1, which everyone is supposed to get after a cancer diagnosis). I prepared myself to ask for and justify the Tadalafil, having heard many people struggle to get it. I walked in and sat down, and after exchanging hellos, how are yous, etc, first thing GP said was "Right, you've started the hormone therapy, let's get you on Tadalafil" - I never had to say a word.

I had expected erections to stop working, but I was lucky and they continued working on hormone therapy, so although I had the Tadalafil at home, I didn't start taking it. Some 6 months later, I did mention this to a urologist, and he said I should be taking it anyway - it's beneficial even if you don't need it for erections, or even if it doesn't work for erections, so I started taking it at that point. About 20% of men can still get erections on hormone therapy, and Tadalafil increases this (although no one has researched by how much). It is important to continue having regular erections to maintain penile tissues, but the involuntary ones will vanish while on hormone therapy. If you can't get them regularly naturally or via Tadalafil, you should as for a pump. (The number of men who can still have sex on hormone therapy is much lower than the number who migt manage an erection.)

I'm not sure Tadalafil is much use regarding the radiotherapy, but it can help protect against the hormone therapy.

Radiotherapy doesn't normally have any impact on erections at the time (except possibly temporarily) although if you're on hormone therapy, you won't be aware of this. If radiotherapy is going to damage erections, what you will find is the erectile function starts deteriorating within 2 years of the radiotherapy, and continues getting worse. Tadalafil will help initially, but you may reach the point where Tadalafil (and the other PDE5 inhibitors) no longer work. An expert in this field said to me if you get to 2 years after radiotherapy and have no deterioration in erectile function, then you swerved that bullet. Erectile function can still deteriorate after that, but the incidence of this drops back the the same level as similar men who never had prostate cancer, so that will be some other reason. (Unexpected erectile dysfunction should always be investigated, because there are a number of potentially serious conditions for which it's a side effect.)

User
Posted 30 May 2026 at 13:14

Yes definitely.  If no one has mentioned it that is a pity. And sexual health is important whatever age or inclination you are. 

If you look on the Movember website they have guidelines there for men on ADT and who are having/ have had Radiotherapy. 

 

https://truenorth.movember.com/images/assets/SexualHealthGuidelines-Patient.pdf

I have found there has been no mention of any of this and its up to yourself to ask for help. Our GP so far has helped but you do have to explain things to her first. Obviously this carries less weight than a directive from an ED clinic or consultant but it's a best option if that's not forthcoming.

If you look on this forum I think a few men are given Tadalafil low daily dose following a RALP

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User
Posted 28 May 2026 at 06:40

Hello Antoinette, No such advice was given to me for my RT - that was June - July 2024 mind so practice may have changed! Was very lucky not to require any aid and erectile functions returned super quick post op (March 2023) and RT.  I was 60 when I had RT, perhaps age helped?!

User
Posted 28 May 2026 at 07:07
Hi Edward husband is on Hormone Therapy so although he never needed the 'blue pill' before, essential now like the pump is to prevent shrinkage etc . Did you not get put on HT?
User
Posted 28 May 2026 at 08:37

Hiya, I was initially prescribed HT (Bicalutamide) alongside RT as they feared my PSA would continue to double. The plan was to start the HT couple of weeks before start of my RT. However, I took 1 pill of bicalutamide in the morning and the oncologist got my latest PSA late that morning and called me that I don’t need to take HT as my PSA hadn’t doubled. Very lucky and i was ecstatic as I had feared the possible side effects of the HT.  The only other medication I was prescribed was Tamoxifen which was to counter breast tissue tenderness - a side effect of HT. I guess the treatment plan has changed and hence the meds to prevent penil shrinkage etc. I haven’t had any shrinkage- yet anyway, as some side effects appear years after treatment as my arousal climactiuria has shown lol.

User
Posted 28 May 2026 at 09:23
My husband's had no breast tenderness. He had 4 weeks of Bicalutamide then after 2 weeks had the first injection
User
Posted 28 May 2026 at 09:44

Fingers crossed your husband’s treatment will go smoothly. Happy to share my experience of this awful condition! Best of luck with it all, to you all. 🙏🏾

User
Posted 28 May 2026 at 13:33

Hi Antoinette,

I started taking 5mg just prior to my HT. I'd bought them online from Pharmica. I think it helps. I was then prescribed 4 x 20mg every 3 weeks along with the pump after my ED clinic meeting.

I've continued to topped up online and tend to take 10mg every other day. If you do buy extra online, I opted to get 20mg tablets as it cheaper, they can be broken into 4 if you wish, they even come with easy break lines, I just half them though.

I think it's Bicalutamide that can cause breast tenderness/growth after a while, it works differently to Zoladex / Prostap. I've not suffered with either.

All the best

John

User
Posted 28 May 2026 at 18:25
I was on 3 yrs Zoladex, starting 2015 aged 59, with 32 sessions of RT to prostate/pelvis to treat T3b, G 8 (upped to 9 after TURP), 2 yrs abiraterone,enzalutimide,prednisolone included on trial.

No Tadalafil etc mentioned or other 'additional' aids. Times change and this was 10 years ago. Things work as they should, no complaints. Maybe if I started treatment aged 70 or so it may have been different?

Peter

User
Posted 28 May 2026 at 20:10

After I'd been diagnosed and put on to hormone therapy, I started reading about it and that Tadalafil could be useful to try and preserve erectile function and prevent long term damage to penile tissue while you have no Testosterone. At the same time, my GP asked me in for an appointment (Cancer Care Review 1, which everyone is supposed to get after a cancer diagnosis). I prepared myself to ask for and justify the Tadalafil, having heard many people struggle to get it. I walked in and sat down, and after exchanging hellos, how are yous, etc, first thing GP said was "Right, you've started the hormone therapy, let's get you on Tadalafil" - I never had to say a word.

I had expected erections to stop working, but I was lucky and they continued working on hormone therapy, so although I had the Tadalafil at home, I didn't start taking it. Some 6 months later, I did mention this to a urologist, and he said I should be taking it anyway - it's beneficial even if you don't need it for erections, or even if it doesn't work for erections, so I started taking it at that point. About 20% of men can still get erections on hormone therapy, and Tadalafil increases this (although no one has researched by how much). It is important to continue having regular erections to maintain penile tissues, but the involuntary ones will vanish while on hormone therapy. If you can't get them regularly naturally or via Tadalafil, you should as for a pump. (The number of men who can still have sex on hormone therapy is much lower than the number who migt manage an erection.)

I'm not sure Tadalafil is much use regarding the radiotherapy, but it can help protect against the hormone therapy.

Radiotherapy doesn't normally have any impact on erections at the time (except possibly temporarily) although if you're on hormone therapy, you won't be aware of this. If radiotherapy is going to damage erections, what you will find is the erectile function starts deteriorating within 2 years of the radiotherapy, and continues getting worse. Tadalafil will help initially, but you may reach the point where Tadalafil (and the other PDE5 inhibitors) no longer work. An expert in this field said to me if you get to 2 years after radiotherapy and have no deterioration in erectile function, then you swerved that bullet. Erectile function can still deteriorate after that, but the incidence of this drops back the the same level as similar men who never had prostate cancer, so that will be some other reason. (Unexpected erectile dysfunction should always be investigated, because there are a number of potentially serious conditions for which it's a side effect.)

User
Posted 28 May 2026 at 20:25
Hi thank you for that really full answer. You were very lucky with your GP. Our is helpful but you do have to ask and explain things to her. She's quite young with 2 small children and my GP too.

No one has suggested anything to us at all. I read a lot and looked on this forum and shared anything yseful with husband. We bought the pump ourselves. His erections lasted a fair while but do not happen spontaneously. He is still quite keen though, and so am I so we both value our relationship very highly indeed. The Sildenafil has been working fine .

He us open to anything, very down to earth and practical. We will just have to get through this together.

User
Posted 29 May 2026 at 14:12

Hi John

Did anyone suggest the Tadalafil or did you just find out about it yourself? As husband is on BP medication as soon as you tick that box on the online pharmacies it just says No you have to ask your GP. I'm fairly sure she will be helpful.

Latest issue to sort out. Yet another CSN phonecall, message waiting for a reply.  A standard letter has come re his last appointment and some blood test labels. And then an ordered medication for 5ml lidocaine on June 13th. ??????

What is that for?? It's a mild numbing injection you get at the dentist.

Also and this is where I start to feel very frustrated we have informed them many times now we are going on holiday on June 13th. This is the holiday we were going to cancel but were encouraged to keep booked by a consultant we saw in February. The dates have been on his notes since then. Radiotherapy noticed them. We repeated them at his last consultant visit on April 28th. We repeated them to the pharmacist who called for his Apalutamide talk. She said ill make a note of them. What is this ? I'm getting so fed up with all this unnecessary nonsense  

User
Posted 29 May 2026 at 14:39

Hi Antionette,

I think it was reading Andy62 profile that alerted me to the existence and use of Tadalafil. I then asked about it when I finally had my ED clinic meeting around 8 months later and it was added to my prescription. Unfortunately those ones aren't nice easy break ones. 

I've not heard of the use of lidocaine before for prostate cancer. However a google search suggests it can reduce cancer progression/invasiveness and recurrence.

You have had a very frustrating time, notes just don't seem to get read, one hand doesn't seem to know what the other is doing, and now extra medication you weren't expecting. It's extra stress you don't need, especially as you'd gone to lengths to point out when you'd be away too.

User
Posted 29 May 2026 at 14:42

Yes we'll get there! 

User
Posted 30 May 2026 at 12:50

Hi all. Just jumping in on this conversation about Tadalafil etc. I had my RALP on 8th May and have had no discussion at all about this or a pump. 

Should everyone having RALP be put on Tadalafil or something similar and maybe offered a pump too.

Not necessarily thinking about sexual function but is it needed at least for good penile health post op.

My follow up with urology is 24th June so maybe I should ask about this then 

User
Posted 30 May 2026 at 13:14

Yes definitely.  If no one has mentioned it that is a pity. And sexual health is important whatever age or inclination you are. 

If you look on the Movember website they have guidelines there for men on ADT and who are having/ have had Radiotherapy. 

 

https://truenorth.movember.com/images/assets/SexualHealthGuidelines-Patient.pdf

I have found there has been no mention of any of this and its up to yourself to ask for help. Our GP so far has helped but you do have to explain things to her first. Obviously this carries less weight than a directive from an ED clinic or consultant but it's a best option if that's not forthcoming.

If you look on this forum I think a few men are given Tadalafil low daily dose following a RALP

User
Posted 30 May 2026 at 13:21

Hi and thanks for your reply. 

To be honest that's why I asked the question as many men on here do seem to taking Tadalafil. Even though I haven't had any discussion so far with urology or my surgeon I was wondering if it's usually just part of the process going forward which someone will eventually bring up.

I will try asking my GP and definitely bring it up at my review on 24th June.

It does seem the journey is very different for lots of men I guess depending on where you are. I feel so sorry especially for the men with a more serious diagnosis on here. 

Good luck to you all.

User
Posted 01 Jun 2026 at 20:48

Hi all. Update regarding Tadafil. I contacted my surgeon's secretary who passed on my question regarding starting Tadafil. His response was that he is happy for me to start taking Sildenafil but I need to request this from my GP. He is happy to write to them if they refuse.

I have submitted an online request to my GP and just waiting to see if they will prescribe without a letter from my surgeon.

Take care all.

Edited by member 01 Jun 2026 at 20:49  | Reason: Not specified

User
Posted 01 Jun 2026 at 21:01
Hi I can't see why not. Husband just asked for it and she said fine. Sildenafil is not quite the same as Tadalafil. It's not an every day pill more of an event tablet
User
Posted 01 Jun 2026 at 21:07

Hi. I'm hopeful they will just issue the prescription but I must admit I was surprised the surgeon suggested Sildenafil rather than Tadafil as it seems Tadafil is the better option for penile health. 

I have a follow up with him on 24th June so I will definitely bring the subject up then and try and get his reasoning on Sildenafil rather than Tadafil.

 
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