Tadalafil (Cialis®) and Daily Low-Dose PDE5 Inhibitors Supporting Penile and Heart Health After Prostate Cancer Treatment

Why this medicine is used

After prostate cancer surgery or radiotherapy, the nerves and blood vessels that control erections can be affected.
This can lead to reduced blood flow, tissue changes, and difficulty achieving erections.

A daily low dose of a PDE5 inhibitor (such as tadalafil 5-6 mg, sildenafil 25–50 mg) is often recommended to:

• Support blood flow to the penis

• Help maintain oxygen and tissue health

• Reduce the risk of scarring or shrinkage (fibrosis/atrophy)

• Encourage natural night-time erections, which are important for recovery

• Improve confidence and sexual well-being while the body heals

What the research shows

1. Penile rehabilitation

• Studies in animals show that regular PDE5i use prevents loss of smooth muscle and fibrosis in penile tissue after nerve injury.

• In men after nerve-sparing prostate surgery, daily tadalafil can improve erections during treatment and may help preserve erectile function over time.

• After radiotherapy, tadalafil does not prevent ED, but remains safe to use.

In short: the goal is to support recovery, not guarantee a full return of erections.
Benefits are greatest while you’re taking the medicine and when used alongside other strategies like a vacuum device or penile stretching program.

2. Heart-health benefits (Tadalafil) (the MACE Study, 2024)

A large U.S. study of nearly 30,000 men with erectile dysfunction found that those taking tadalafil had:

• 19% fewer major heart events (heart attack, stroke, heart failure, etc.)

• 44% lower risk of death from any cause

• Fewer hospitalisations for chest pain and heart procedures

• Greater benefit in men who took tadalafil more consistently

Researchers believe tadalafil may:

• Improve blood-vessel health (endothelial function)

• Reduce inflammation and blood pressure slightly

• Enhance oxygen delivery and protect heart cells

While this doesn’t prove tadalafil prevents heart disease, it’s reassuring for men using it long-term for ED or penile rehabilitation.

How to take it

• Usually one tablet daily (tadalafil 5-6 mg) at the same time each day

• Start when advised by healthcare provider — often once the catheter is removed after surgery

• Continue for 6–9 months or as directed

• Combine with other therapies if recommended (vacuum device, injections, pelvic-floor work)

Possible side effects

• Headache

• Flushing or mild dizziness

• Stuffy nose or indigestion

• Muscle aches (tadalafil)

These are usually mild and settle with time.

 Do not take PDE5 inhibitors with nitrate heart medicines (GTN spray, nitroglycerin tablets, or “angina” patches).
Discuss with your healthcare provider if you have low blood pressure or heart disease.

When to contact your prescribing health professional

• If you have chest pain (go to emergency department), fainting, or vision changes, experience any other side effects.

Bottom line

Daily low-dose tadalafil (Cialis®) can support penile tissue health after prostate cancer treatment — and may also benefit overall heart health.
It’s safe for most men, helps preserve erectile function, and may lower the risk of heart problems.
Use it regularly, follow your rehabilitation plan, and stay in touch with your healthcare team.

It has been shown that taking this medication long term for penile health and heart health may be beneficial.

Reference List (APA 7th Edition)

Kloner, R. A., Stanek, E., Desai, K., Crowe, C. L., Ball, K. P., Haynes, A., & Rosen, R. C. (2024). The association of tadalafil exposure with lower rates of major adverse cardiovascular events and mortality in a general population of men with erectile dysfunction. *Clinical Cardiology, 47*(2), e24234. https://doi.org/10.1002/clc.24234

Andersson, D. P., Landucci, L., Lagerros, Y. T., et al. (2021). Association of phosphodiesterase-5 inhibitors versus alprostadil with survival in men with coronary artery disease. *Journal of the American College of Cardiology, 77*(12), 1535–1550. https://doi.org/10.1016/j.jacc.2021.02.003

Anderson, S. G., Hutchings, D. C., Woodward, M., et al. (2016). Phosphodiesterase type-5 inhibitor use in type 2 diabetes is associated with a reduction in all-cause mortality. *Heart, 102*(21), 1750–1756. https://doi.org/10.1136/heartjnl-2015-308932

Hackett, G., Jones, P. W., Strange, R. C., & Ramachandran, S. (2017). Statin, testosterone, and phosphodiesterase 5-inhibitor treatments and age-related mortality in diabetes. *World Journal of Diabetes, 8*(3), 104–111. https://doi.org/10.4239/wjd.v8.i3.104

Padma-Nathan, H., McCullough, A. R., Levine, L. A., et al. (2008). Randomized, double-blind, placebo-controlled study of nightly vs. on-demand sildenafil for penile rehabilitation after bilateral nerve-sparing radical prostatectomy. *The Journal of Sexual Medicine, 5*(9), 2116–2123. https://doi.org/10.1111/j.1743-6109.2008.00881.x

Pisansky, T. M., et al. (2014). Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: The randomized, double-blind, placebo-controlled RTOG 0831 trial. *JAMA, 311*(13), 1300–1307. https://doi.org/10.1001/jama.2014.2626

Montorsi, F., et al. (2008). Nightly vs on-demand vardenafil for erectile dysfunction after nerve-sparing radical prostatectomy: Results of a randomized, double-blind trial. *European Urology, 54*(4), 924–931. https://doi.org/10.1016/j.eururo.2008.06.093

Vestergaard, N., Søgaard, P., Torp-Pedersen, C., & Aasbjerg, K. (2017). Relationship between treatment of erectile dysfunction and future risk of cardiovascular disease: A nationwide cohort study. *European Journal of Preventive Cardiology, 24*(15), 1498–1505. https://doi.org/10.1177/2047487317712478