When to Stop Daily Use of PDE5s

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Veteran Member

Date Joined Dec 2009
Total Posts : 1268
   Posted 1/1/2011 2:19 PM (GMT -6)   
I've been taking low dose PDE5 inhibitors (viagra, cialis, levitra) daily for rehab and full doses for sex.  I've followed the advice given in Mulhall's book on how much to take and when.  It's been a long process but things keep improving with time (it'll be two years in April since the DaVinci), and a few months back I had my first (and only?) nocturnal erection (NE).
My question is "How long should I keep taking the low dose PDE5 inhinitor?".  I could see if I was having NEs on a constant basis that maybe enough oxygen was reaching the target and that I could quit the PDE5s.  But with non-consistent NEs I tend to think that I should stay on the PDE5 inhibitors.  But for how long .... forever?
I did not see any clear guidance in Mulhalll's book and my doctor ... well I'm switching docs in February.  Any insight on how long to stay on the LOW DOSE PDE5 inhibitors, or when to go off of them, would be greatly appreciated.
Happy New Year.
PSA 2007 - 2.8; 11/24/2008 - 7.6; PCa Dx 2/11/09; age at Dx 62; RLP 4/20/09

Biopsy - Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex. 70 gram prostate. Continent after removal of cath.

ED - Trimix works well; levitra @ 90%
PSA - 7/31/09 <0.06; 12/1/09 <0.06; 3/29/10 <0.06; 8/4/10 <0.06

Post Edited (RCS) : 1/1/2011 12:23:07 PM (GMT-7)

Veteran Member

Date Joined Jul 2010
Total Posts : 3887
   Posted 1/1/2011 2:38 PM (GMT -6)   
With most drugs, if you take them continuously and long enough, your body starts to ignore them, their effect diminishes..

So in February I would ask your new doctor the same question..

I've always thought that when surgeons prescribe ED drugs, they are just diverting attention from their less than perfect work and hoping the drugs might have some sort of salvage effect on potency...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 1/1/2011 5:09 PM (GMT -6)   
I'm also not convinced about how effective a low daily dose of PDE5 inhibitor really is. Apart from a few (ineffective) samples of Cialis, I have not used them -- my uro's advice was that for the non-nerve-spared like me, they don't work.

I had non-nerve-spared RRP nearly 3 years ago. Started getting occasional NEs at about 14 months. At the time I was using Bimix about twice weekly for sex, and on most other days the pump for exercise. NEs have continued at about monthly intervals that I am aware of. Never any morning wood.

Now I no longer use Bimix, pump only about 3 or 4 times a week, and find that what I get continues to be good enough for sex. I have the occasional week away with no anything, without any ill effects, in fact the breaks may have done me good. Certainly no backwards steps.

So my conclusion is that it doesn't really matter how you get your erections so long as you get them. I expect that for me once a week would be enough -- but of course your mileage may vary.

RCS: If the full dose of Levitra almost works for you then I suggest continue taking it, and the Trimix too. But my inclination would be to stop the daily low dose for a month or two, and see if the are any adverse effects -- I expect there won't be.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.3, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

Veteran Member

Date Joined Dec 2009
Total Posts : 1268
   Posted 1/2/2011 8:03 AM (GMT -6)   
Thank you for your suggestions.  I'll ask the new doctor what he thnks; however, I'm leaning towards Piano's suggestion of discontinuing the low dose PDE5 inhibitors for a couple of months and see what happens.  I agree that obtaining an erection, by any method, probably helps recovery.
Mulhall sites evidence that low-dose PDE5 inhibitors (Viagra and Levitra) help penile rehabilitatioin by getting oxygen to the penis; however, I'm not sure if the improvement I've seen has been due to the PDE5 inhibitors or natural healing.  I've had the suspicion that maybe I've bought a lot of stuff (VED, Viagra, Cialis, Levitra, etc.) that
made me think I was doing something to improve the ED; however, maybe the improvement I have seen would have occured naturally.
Oh well, if nothing else its been interesting, and given me something to think about. wink

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4848
   Posted 1/2/2011 8:55 AM (GMT -6)   
You're almost at the two year make. Me thinks you're rehab is pretty much over.. Espicially if the pills work ok for intercourse.

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 1/2/2011 10:03 AM (GMT -6)   
The PDE5's have almost certainly helped the natural healing. They are not two separate issues. The recovery process for ED after surgery is a process that can take up to five years to get to the point of no more improvement. Many, many men see a big bump in progress after the two year mark. Each man is different. A responsible doctor will not declare a certain time is the cut off for improvement. But for therapy, as these guys have said, the window is probably closed. That does not mean that improvement is over, however.

Bottom line, after two years, you can certainly discontinue the low does meds. But every day you must get at least one good erection. It can be through pump therapy, oral meds and sex, injections, or, for many men, extended ********** can produce a therapeutic erection.

use it or lose it is still true.
Founder, Erectile Dysfunction Foundation and creator of www.franktalk.org The site for erectile dysfunction.

46 at Diagnosis.
Davinci at 47.
Doing fine.

Veteran Member

Date Joined Dec 2009
Total Posts : 1268
   Posted 1/2/2011 3:14 PM (GMT -6)   
The advice really helps.

Regular Member

Date Joined Feb 2010
Total Posts : 385
   Posted 1/3/2011 2:25 AM (GMT -6)   
My urologist said that these drugs won't do anything unless there is some nerve function. Nitrous oxide is secreted when the nerves activate, which activated cGMP. The PDE5 inhibitors like Vigra, allow the cGMP to build up, which dilates the blood vessels and engorges the penis. No nerve function, the Vigra has no effect. He suggested use of the vacuum pump. The idea is to prevent atrophy (shrinkage) of the penis. Normally men get erections during REM sleep (dreaming sleep), which maintains the size of the penis. No nerve function, no erections during REM, so the pump is a substitute. The penis needs to get expanded once in a while to maintain normal erection size.
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