Tadalafil (Cialis) Improves BPH Symptoms
Abstract & Commentary
By Joseph E. Scherger, MD, MPH, Professor, University of California, San Diego. Dr. Scherger reports no financial relationship to this field of study.
Synopsis: A randomized controlled trial of 281 men with BPH showed that once daily Tadalafil (Cialis) 20 mg improved lower urinary tract symptoms compared with placebo.
Source: McVary KT, et al. Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urology. 2007;177:1401-1407.
In this study, investigators from the Department of Urology at Northwestern University in Chicago studied 281 men age 45 and older with known BPH on medications. Twenty-one centers in the US participated. All men agreed to a 4 week treatment-free washout period, which was followed by 4 weeks on a placebo. The men were then randomly assigned to receiving Tadalafil or placebo for 12 weeks. The Tadalafil group initially received 5 mg daily for 6 weeks and then the dose was increased to 20 mg daily if tolerated. Symptoms of BPH were determined using the International Prostate Symptom Score (IPSS) questionnaire.
Complete follow-up occurred for 89% of the patients through 12 weeks. The investigators and study participants remained blinded to their treatment and their IPSS scores at baseline and during the study.
The Tadalafil group was more likely to report a 3 point or improvement in their IPSS scores than the placebo group (60.9% vs 42.7% with a number needed to treat of 6). Interestingly, the men with comorbid erectile dysfunction had the greatest improvement of their BPH. The greatest improvements in the IPSS were in the irritative and obstructive domains of the questionnaire.
Commentary
Benign prostatic hypertrophy (BPH) and erectile dysfunction (ED) are two of the most common conditions of middle aged and older men. Having one well tolerated drug which treats both would be a major breakthrough indeed.
The long acting properties of Tadalafil make it unique among the drugs for erectile dysfunction. With up to 36 hours of effectiveness for ED, I wonder if taking the drug less often, perhaps every other day, would still improve the BPH symptoms. The mechanism of action of Tadalafil in improving BPH symptoms was not explored.
The improved circulation effects of Tadalafil and the other ED drugs make them attractive potential agents for a number of other conditions, such as cardiovascular disease. I suspect we will see a number of studies of the ED drugs in other conditions, especially the longer acting Tadalafil. I will start asking my patients on Tadalafil, "Do you notice anything else getting better?" The answers might be a basis for another study.
A randomized controlled trial of 281 men with BPH showed that once daily Tadalafil (Cialis) 20 mg improved lower urinary tract symptoms compared with placebo.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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