VIAGRA NEWS

Source: Daily Mail

Date: 6-Feb-2012

Author: Dr Martin Scurr

Q : For the past 16 years I have suffered with an enlarged prostate.

My doctor allowed me to have low-dose Sildenafil Citrate tablets for erection problems in the past year, however my last PSA test showed a jump in the reading - could Sildenafil Citrate be enlarging my prostate?

I also have stents fitted in one of my arteries (I am 72). I am not using the tablets more than once a month, but would like to use them more often.

Anonymous.



A : Let me first reassure you on the use of Sildenafil Citrate - it would have had no effect on your prostate, for reasons I will explain.

You have described four separate problems: enlarged prostate (also known as benign prostatic hypertrophy), erection problems, a raised PSA test and coronary heart disease. There may be some links between them, and so it is worth considering each in turn.

Benign (non-cancerous) enlargement of the prostate gland affects most men to a greater or lesser extent as they grow older.

The main symptom is a weakened stream of urine when emptying the bladder. This is because the urethra, the tube that carries the urine, goes through the middle of the prostate as it exits the bladder.

As the prostate gland enlarges, this narrows the urethra. It also distorts the shape of the base of the bladder, which makes you need to get up two or more times a night to visit the loo (a problem called nocturia).

You are concerned that your condition may have become worse due to the fact that your PSA (prostate specific antigen) test is higher.

First, Sildenafil Citrate is not the problem here as it works by widening blood vessels and increasing blood flow to the penis, so does not actually act on the prostate itself.

Second, the PSA test itself is not reliable or specific enough to be interpreted as a sign that your enlarged prostate is getting larger.

The test measures the levels of a protein produced by both normal and cancerous prostate cells, but levels can jump up for many reasons, such as constipation or recent sexual activity.

A raised PSA level can sometimes be a sign of cancer, but in at least 25 per cent of cases it isn't, and when tumours exist they are often so small and slow-growing that no action is needed.

We are aware that PSA levels do increase with age, reflecting the greater volume of prostate tissue in older men but the test is too non-specific and unreliable to be regarded as a guide to an increase in prostate volume.

While Sildenafil Citrate won't affect your enlarged prostate it might have implications for your coronary heart disease.

Sildenafil Citrate relaxes the muscle that lines the blood vessels. The heart itself is not affected, but if you are taking a nitrate for angina, then Sildenafil Citrate is not suitable as the combination can cause a catastrophic drop in blood pressure.

Nitrates are used for angina (heart pain caused by reduced blood supply to the heart muscle) and work by widening the blood vessels, allowing blood to flow more easily - so, taken with Sildenafil Citrate, the blood vessels would be widened even further.

I would hope that you are not on such treatment because your stents (wire tubes inserted to widen arteries) should ensure good blood flow.

It may be that the erection problems relate to your heart disease. Another possible cause is the medications you're taking for your heart.

If you're taking a beta blocker or an ACE inhibitor, check with your GP that these might not be the cause of your recent history of erectile dysfunction.

Even if they are, Sildenafil Citrate is still allowed. So, as long as you are not on a nitrate, carry on with Sildenafil Citrate as often as you like.