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RECENT Prostate Cancer QUESTIONS
All questions are answered by Dr. William J. Catalona.
I have just re-ordered my next refill on Cialis (tadalafil) and have questions concerning erectile dysfunction medications. At my physical examination this past summer, my primary care physician seemed a bit surprised that I was taking 20 mg Cialis daily. Am I doing something wrong? He seemed concerned about the dosage. Also, my new prescription just cost me $230. Many of these drugs seem to be reaching ‘generic’ stage. Shouldn't the costs be coming down? Also, I seem to have a sex drive that is reduced.
You can now get tadalafil (Cialis) through GoodRx at less than $1 per 20 mg pill. If you are taking this drug daily, because of its longer half-life in your body, the recommended dose is only 5 mg; whereas, for “on-demand” use, the dose is 20 mg.Sex drive is usually related to the blood testosterone level. You should have an early morning blood draw for testosterone. Visit my website at www.drcatalona.com and search the terms “testosterone,” “libido,” and “erectile dysfunction” for more information.
In the past you recommended stopping taking essential fatty acids as a daily supplement, so I stopped that supplementation. Now, my ophthalmologist would like me to take the daily supplement “Preservision” Areds 2. This supplement contains: vitamin C 250 mg, vitamin E 90 mg, zinc 40 mg, copper 1 mg, lutein 5 mg, Zeaxanthin 1 mg. The ingredients are: ascorbic acid, di-alpha tocopheryl acetate gelatin, glycerin, zinc oxide, marigold flower extract, medium chain triglycerides, carmine, zeaxanthin5, cupric oxide, titanium dioxide. Is it okay for me to take this supplement?
I had a radical prostatectomy for prostate cancer 12 years ago followed by salvage radiation therapy to the prostate bed one year later. My PSA began to rise slowly over the course of the last 10 years and has been treated with hormonal therapy. My pressing issue, however, has been my bladder. I’ve had severe spastic pain with urgency over the last six months and am voiding small volumes every one to two hours. I have tried bladder relaxing and anti-inflammatory medication with little relief. My urologist performed Botox injections into my bladder; that did nothing but make my symptoms worse. I do not retain urine, and my bladder can’t hold more than 200cc without having to void. The working diagnosis is radiation cystitis. My urinalysis and urine cytology are negative. I started Trental with vitamin E recently. Might you have any recommendations?
There have been numerous studies suggesting there is a benefit of hyperbaric oxygen therapy for radiation cystitis. The first prospective randomized trial (from Sweden: Oscarsson N et al, Lancet Oncol 2019; 20:1602-14) demonstrated that it relieves symptoms and is safe and well tolerated. Fortunately, there are hyperbaric centers in the U.S. that can provide this form of treatment. I have had several patients who state that they improved after hyberbaric oxygen therapy.
Unfortunately, my PSA is detectable after my radical prostatectomy, meaning that there are prostate cancer cells remaining that should be treated. I have been advised to begin “salvage radiation therapy” as soon as I have completely recovered my urinary continence. If I start the salvage radiation therapy before I am continent, will I then remain incontinent? How long can I safely wait to begin the radiation treatments before I lose the chance for a cure?
If you receive the radiation therapy before you are continent, it is unlikely that you will ever achieve complete continence. It is difficult to project how long it will take for any individual to recover complete continence after surgery, or even if he will ever become completely continent, although the great majority do. However, you should give urinary control every chance to recover.
Based on recent studies (see page 10), many radiation oncologists recommend hormonal therapy for at least two months before starting salvage radiation therapy, all during radiation therapy, and for at least one year after radiation therapy. While on hormonal therapy, your PSA should fall to the “undetectable” range. In addition, patients can continue the pre-radiation phase of the hormonal therapy for longer than two months, if necessary, while waiting for continence to return. Nevertheless, you should be religious with performing Kegel exercises, four sets of 10 per day.
The Bi-mix injections that I am using for erectile dysfunction (Bimix, papaverine 30 mg/mL phentolamine 5 mg/mL) at 40 units are not giving me good results. Is it possible to increase to a stronger formula?
You could increase the amount of Bi-Mix 30-5 that you inject up to 100 units (1 mL). There is a 100 unit syringe with the same ultrafine 31 gauge as you have been using on the 50-unit syringe. Other options include Tri-Mix, Quad-Mix, or Super Quad- Mix. All of the latter include a drug called alprostadil that causes aching after injection in about 15% of patients.
FREQUENTLY ASKED Prostate Cancer QUESTIONS & ANSWERS
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