Catalona Vanderbilt

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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 and search the terms “testosterone,” “libido,” and “erectile dysfunction” for more information.

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.


Click on the category of your question or concern.

Biopsy, Digital Rectal Exam (DRE) & Gleason Score

Initial Treatments After Diagnosis of Prostate Cancer

Conditions After a Radical Prostatectomy

Continence (Urinary Concerns)

Sexual Potency After a Radical Prostatectomy

Post Operative Treatment and Treatment Upon Recurrence

Hormonal Therapy

Information About the Prostate Gland

Other Conditions of the Prostate

Prevention, Nutrition, & Lifestyle


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