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Correct Cialis dosage after RALP?

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Posted 3/15/2016 12:47 AM (GMT 0)
I have benefited greatly from the wisdom in this forum. I wonder what others think about the correct dosage of Cialis or Viagra after surgery. I'm nearly 3 months out of surgery now, and I'm preparing for my 3-month follow-up.

My surgeon told me that after surgery, the nerves take 3 months-1 year to regenerate. He prescribes Viagra or Cialis after surgery to help restore blood flow to the region.

He put me on a dosage of 5mg of Cialis twice a week, so that amounts to a total of 10 mg per week. I had noticed that others in this forum have reported different dosages, so I was wondering if there is any scientific evidence regarding what dosage works the best to restore blood flow after surgery.

The 10mg per week is doing nothing for my persistent ED, and I didn't really expect that it would, since it's probably too soon. But I do wonder if there is any scientific consensus about the correct dosage.

______________
Age 59
Biopsy on 10/29/2015 showed Gleason 3+4=7, positive 6 out of 12 cores
RALP on 12/23/2015
Cancer was contained, surgical margins were free of tumor. No detected Extraprostatic extension; no Seminal Vesicle or Lymph-Vascular invasion identified. Woo hoo!
Final Gleason 3+4=7, Stage T2c
Incontinence: stopped wearing pads 4 weeks after catheter removal. Minor leakage for another month after heavy exercise. Two and a half months post-cath, started wearing boxers again. Woo hoo!
Posted 3/15/2016 1:18 AM (GMT 0)
The short answer is to try different things and see what works, for you. I did 5 mg daily for a while, and have moved down to 2.5 mg daily. I'm not even sure I even need it.

Part of the issue for me had to do with what insurance would pay for. For daily use, I have to pay out of pocket at full price until my deductible is met. It's surprising what a 90 day supply costs. Insurance is weird on it.

You could move up to 10 mg a day, probably with no problems. Frequently I've seen 10 mg daily with a 'boost' when the opportunities appear.
Posted 3/15/2016 1:48 AM (GMT 0)
The last study I read said that "on demand" is better than "daily" after surgery because it can interfere with recovery from incontinence (ED meds increase flow - great for after radiation, not so great after surgery). So for Cialis, that would be 20 mg; for Viagra, 50 or 100 mg. You have to find the drug and the dose that works for you.

I think most professionals advocate a multi-pronged attack - daily pumping, ED meds and trimix on-demand, and working it as often as you can.

- Allen
Posted 3/15/2016 2:03 AM (GMT 0)
My doc had me taking 25mg Viagra/day (100 mg, quartered) and up to the whole 100mg tablet when the 'opportunity' arose (no pun intended!). Insurance only covered 6 per month, so even with that 'new math' eventually I was going to have to pay for a couple more out of pocket. Well, those extra 2 tablets per month are $50 each combined with my regular $20 copay! So, now I take 4-5 doses per week to keep things hopefully flowing, and save what I can for opportunities. The doc also told me to be sure to have stimulation, even if done by myself. I spoke to my regular doc about a few things recently and he mentioned the 20mg generic sildenafil. He said I'd likely have to pay for it out of pocket as it's really prescribed for pulmonary ailments, not ED, but he said it would be worth checking into factoring the out of pocket costs between the name brand Viagra @ 8 tabs/month and a 30 day supply of the generic stuff.

You're still not too far out from surgery, so I wouldn't get too worried over things at this point. At 7 months, I can make it work at least.
Posted 3/15/2016 10:43 AM (GMT 0)
TA, interestingly enough, I found that taking it seems to HELP the minor occasional leakage I experience. Or maybe it's wishful thinking. When I talked to the Uro about it, he said that he's seen it work both ways when it comes to continence.
Posted 3/15/2016 12:56 PM (GMT 0)
There is no one right or wrong answer to your question. If you ask 10 different surgeons what their protocol is after RALP, you will probably get five different answers evenly distributed. The responses you received here so far clearly support that notion. You can either follow your doctor's orders, or as some here seem to have done, just do your own thing. I suggest following doctors orders. Cost will soon be an issue, which may then lead you to doing your own thing.
Posted 3/15/2016 2:37 PM (GMT 0)
I have been doing 5mg daily Cialis for some time with good results and very few side effects. Yes cost can and did become an issue for me at $6.50 / daily dose. No insurance coverage what so ever.

Forum rules prohibit us from openly discussing alternative pharmacy sources but I can share the source I use via Email where the cost comes down to .65 / daily dose. Seems to work just as good at a tenth of the price.

Jon
Posted 3/15/2016 5:00 PM (GMT 0)
Halbert,
You're quite right to point out that randomized clinical trials only predict the effect for the population as a whole, while individual results may vary. I haven't seen anything on their use in the situation of salvage radiation after surgery when a man can have a combination of incontinence and retention. The nice thing about on-demand is that it can be a lot less expensive than nightly pills. Here's the study, if you're interested:

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

- Allen
Posted 3/15/2016 9:49 PM (GMT 0)
I absolutely recommend you get Dr. John Mulhall's book. Link below. Should be required reading for any man with PC before treatment, in my opinion.

Gedman
Posted 3/15/2016 11:18 PM (GMT 0)
The idea that ED drugs taken even before treatment helps with both ED and continence comes straight from Dr. Mulhall. My Uro put it this way: healing of any injury is helped by increasing blood flow, so healing the urinary muscles that help you hold urine is helped by increasing blood flow. At least that's the theory.
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