Can tadalafil 5mg be used for an enlarged prostate?

You may be familiar with the once-daily erectile dysfunction tablet Cialis 5mg or tadalafil 5mg, but did you know that it can also help with an enlarged prostate? In this blog, we will review the journey towards the discovery that, in addition to erectile dysfunction, tadalafil 5mg can also help with an enlarged prostate or benign prostatic hyperplasia.

Key takeaways

• Tadalafil 5mg is approved in the EU for treating both erectile dysfunction and BPH symptoms with one daily tablet, simplifying treatment for many men [1][4][5].
• BPH and erectile dysfunction often occur together; tadalafil 5mg targets both, improving quality of life [7][8][9][10].
• Studies show tadalafil 5mg daily is effective for urinary symptoms and may outperform alpha-blockers in sexual function improvement [12][13][14].
• Combination therapy with alpha-blockers can enhance symptom relief but may increase mild side effects [10][12][14].
• Personalised treatment plans, lifestyle changes, and open communication with healthcare professionals are key to managing BPH effectively [6][2].

Introduction: Why talk about BPH and tadalafil?

If you’re a man over 50, you might have noticed a few changes in your bathroom routine—like getting up at night to wee, or feeling like you never quite finish. You’re not alone. Benign prostatic hyperplasia (BPH), or an enlarged prostate, is a fact of life for millions. It’s not cancer, but it can make life awkward. Even worse, it often comes with erectile dysfunction (ED). The good news? There’s now a single daily tablet—tadalafil 5mg—that tackles both problems [1].

In this deep dive, we’ll explain what BPH is, how tadalafil 5mg works, what the research says, and how to get the most from your treatment. We’ll also answer the questions men ask most, and share practical tips.

What is benign prostatic hyperplasia (BPH)?

BPH is a non-cancerous enlargement of the prostate gland. The prostate sits just below the bladder and wraps around the urethra (the tube you pee through). As men age, the prostate often grows—sometimes squeezing the urethra and making it harder to empty the bladder [2].

Common symptoms include:

• Needing to urinate more often, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted flow
• Feeling like your bladder isn’t empty
• Dribbling after you finish

These symptoms can creep up slowly, but they can really impact sleep, travel, and confidence. If you’re nodding along, you’re in good company—BPH affects about half of men over 50 [2]. Global estimates show an increasing prevalence worldwide, from 51.1 million cases in 2000 to 94.0 million cases in 2019 among men aged 40 years and over [17].

Understanding benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a common condition where the prostate gland enlarges, typically affecting men over 50 [2]. This enlargement can compress the urethra, leading to urinary symptoms such as frequent urges, weak flow, and difficulty emptying the bladder [2].

While BPH is not cancerous and doesn’t increase cancer risk, it can significantly impact daily life and sleep quality. Many men with BPH also experience erectile dysfunction (ED), highlighting the overlap between urinary and sexual health [3][7].

Who is affected by BPH and why?

BPH is primarily linked to ageing and hormonal changes, with genetic factors playing a role. Lifestyle factors such as obesity, diabetes, and cardiovascular health also influence risk [2],[9], [15].

Symptoms develop gradually, and early consultation with a healthcare professional is advisable if urinary changes occur.

Researchers are still trying to find out what exactly causes the prostate to grow as men age, and have come up with several theories, which are summarised below. BPH, or benign prostatic hyperplasia, doesn’t have a single cause. Instead, it’s likely the result of several factors working together:

Hormones:

Male hormones like testosterone (made mainly in the testes) travel through the blood to the prostate. Inside the prostate, an enzyme converts testosterone into a more potent hormone, DHT, which helps the prostate grow and function.

As men age, testosterone levels in the blood drop, but the prostate keeps using DHT. At the same time, the balance between male and female hormones (oestrogens) changes, which may encourage the prostate to grow bigger.

There’s also something called the “saturation theory”. Think of hormone receptors in the prostate like parking spaces for hormones. These spots get filled up even at low hormone levels, so once they’re full, adding more hormones doesn’t make much difference. This helps explain why changes in blood testosterone don’t always affect prostate growth—the receptors are already “saturated” and working at full capacity [16].

Genetics:

Benign prostatic hyperplasia (BPH) often runs in families. If your dad or brother had it, your risk is higher. Specific gene changes might make the prostate more likely to grow, but there isn’t one single “BPH gene.”[15].

Metabolic health:

Men with diabetes or high insulin levels are more likely to develop BPH. Insulin and related hormones can act as growth signals, telling prostate cells to multiply [15].

Inflammation:

Long-term inflammation in the prostate can trigger the release of chemical signals called growth factors. These signals tell cells to multiply, which can make the prostate bigger over time [15].

Cell growth and stem cells:

The prostate contains stem cells that can make new cells when needed. As men age, these stem cells may become more active, leading to extra growth. An enzyme called telomerase might also help these cells keep dividing [15].

Growth factors:

These are special proteins that tell cells when to grow or stop. In BPH, certain growth factors are elevated, especially in the presence of inflammation, leading to prostate enlargement [15].

Why is BPH so tricky to understand?

A mix of ageing, hormonal changes, genetics, inflammation, and lifestyle factors probably causes BPH. This “perfect storm” means some men get BPH and others don’t, and it’s why treatments don’t always work the same for everyone.

What does this mean for treatment?

Because there’s no single cause, treatments focus on easing symptoms:

• Medicines to shrink the prostate
• Medicines to relax the muscles in the prostate and bladder neck
• Anti-inflammatory drugs or lifestyle changes
• Surgery, if needed

Researchers hope that by identifying the actual root causes, future treatments will be more targeted and more effective.

Diagnosing BPH

Diagnosis involves symptom assessment, physical examination, including a digital rectal exam (finger up the bottom), and tests such as urine analysis and PSA blood tests to exclude prostate cancer [2]. Additional investigations may include bladder scans and urine flow studies for severe cases.

The link between BPH and erectile dysfunction (ED)

Many older men experience both sexual problems and lower urinary tract symptoms (LUTS), such as needing to pee more often, having a weak stream, or difficulty starting to pee.

These symptoms are often caused by benign prostatic hyperplasia (BPH), which is the medical term for an enlarged prostate. Research shows that sexual dysfunction and LUTS are closely linked, and it’s common for men with one problem also to have the other [9]. About half of men with BPH also have trouble getting or keeping an erection [3].

Why? The two conditions share some biological pathways—especially the nitric oxide–cGMP system, which controls blood flow and muscle relaxation in both the penis and the lower urinary tract [7]. This overlap means treatments addressing both conditions can improve overall well-being.

How common are urinary and sexual problems in older men?

The MSAM-7 study: What did researchers find?

A large study called MSAM-7 looked at men aged 50 to 80 across the US and Europe to understand how common urinary and sexual problems are as men get older. It found that over half of men in this age group have lower urinary tract symptoms (LUTS), such as needing to pee more often, a weak flow, or trouble emptying the bladder.

Many of these men also experience sexual problems like difficulty getting or keeping an erection, less semen, or pain during ejaculation. These issues become more common and more severe with age [7].

The Boston study: A closer look at ageing, urinary issues, and erectile dysfunction

Another study in Boston looked at over 2,300 men from different backgrounds to understand how common urinary problems and erectile dysfunction (ED) are as men age.

It found that urinary problems, like needing to pee at night or leaking, become more common with age, rising from 8% in men aged 30-39 to 26% in men aged 70-79. Erectile dysfunction also increases with age, affecting about 10% of younger men and nearly 60% of older men [8].

Which urinary symptoms are most linked to ED?

The study showed a link between urinary problems and ED, especially with symptoms like needing to pee at night (nocturia), incontinence (leaking), and signs of prostate inflammation (prostatitis).

Why do these problems matter for men’s health?

However, when other health issues were taken into account, the connection between general urinary symptoms and ED was less clear. This means certain specific urinary problems may play a bigger role in causing sexual difficulties [8].

Overall, the study highlights that both urinary problems and ED are common in older men and can affect quality of life. These issues are similar across different races and ethnicities. It’s important for men experiencing these symptoms to talk to their doctor, as managing urinary problems may also help with sexual health.

Why are erectile dysfunction and BPH connected?

Doctors aren’t entirely sure why these problems are connected, but several ideas help explain it. One key factor is the nitric oxide (NO)–cGMP pathway.

The nitric oxide (NO)–cGMP pathway

Nitric oxide is a natural chemical that helps relax the smooth muscles in the penis, bladder, and prostate.

When NO triggers cGMP, muscles relax, allowing blood to flow into the penis for an erection and helping the bladder and prostate work properly for normal urination. If this pathway is disrupted, men can have trouble with erections and urinary symptoms like urgency or weak flow [9].

The RhoA–Rho-kinase (ROCK) pathway

Other important systems include the RhoA–Rho-kinase (ROCK) pathway, which controls muscle contraction. When this pathway is overactive, muscles stay tight, leading to bladder overactivity and harder erections.

The autonomic nervous system, which controls automatic body functions like bladder control and blood flow, can also become overactive in men with BPH, worsening both urinary and sexual problems.

Pelvic atherosclerosis

Additionally, pelvic atherosclerosis—the narrowing of blood vessels in the pelvic area—can reduce blood flow, damaging tissues and contributing to these symptoms. Health conditions like high blood pressure, diabetes, and high cholesterol increase the risk of atherosclerosis, linking them to BPH and sexual dysfunction [9].

Treatment options for BPH

Management ranges from lifestyle changes—reducing caffeine, managing fluid intake, and pelvic floor exercises—to medications and surgery for severe symptoms [2].

Commonly used medications include alpha-blockers (e.g., tamsulosin), 5-alpha-reductase inhibitors (e.g., finasteride), and PDE5 inhibitors (e.g., tadalafil) [4][9].

Surgery is considered when medications are insufficient or complications arise.

Alpha blockers and DHT blockers (5-alpha-reductase inhibitors) work, but they have their downsides—alpha-blockers can cause dizziness or ejaculation issues, and 5-alpha-reductase inhibitors can reduce libido or cause ED [4].

Surgery is usually reserved for severe cases or when other treatments fail. It can be very effective, but it’s not without risks.

Alpha blockers

Alpha blockers work by relaxing the muscles in the prostate and the bladder neck, which can tighten and block urine flow. They block alpha-1 adrenergic receptors, helping muscles relax and urine flow more freely, providing quick symptom relief. However, alpha blockers don’t shrink the prostate itself.

DHT blockers

DHT blockers work differently by reducing levels of dihydrotestosterone (DHT), a hormone that causes the prostate to grow. These medicines shrink the prostate over time, improving symptoms gradually [9].

The problems with alpha and DHT blockers

Both types of medicines can affect sexual function differently. Alpha blockers may cause dizziness or ejaculatory problems, while DHT blockers can sometimes reduce sexual desire or cause erectile dysfunction [9].

How does tadalafil 5mg work for BPH?

Tadalafil is best known as the active ingredient in Cialis, a popular erectile dysfunction treatment. But in 2012, the European Commission approved daily tadalafil 5mg for men with BPH—with or without ED [1].

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor. It works by boosting the nitric oxide–cGMP pathway, relaxing smooth muscle in the bladder, prostate, and blood vessels. This improves urine flow, reduces symptoms, and—bonus—helps with erections [5].

Unlike some medications, tadalafil doesn’t shrink the prostate, but it makes it easier to pee and improves quality of life. And because it’s taken once daily, you don’t have to plan around it.

Interestingly, phosphodiesterase type 5 inhibitors (PDE5-Is) like tadalafil (Cialis), which are usually used for erectile dysfunction, can also improve urinary symptoms in men with BPH. They work by enhancing the NO-cGMP pathway, helping muscles relax and improving blood flow. Studies show that PDE5-Is can safely and effectively treat men with BPH who also have ED, sometimes combined with other medicines for better results [9].

In summary, urinary and sexual problems in men with BPH are closely linked through several biological pathways involving muscle control, nerve activity, and blood flow. Treatments need to balance relieving urinary symptoms while preserving or improving sexual function. Open communication with healthcare providers is vital to find the best approach for each man’s health and lifestyle.

What does the research say about using tadalafil for an enlarged prostate?

Multiple extensive studies and meta-analyses show that daily tadalafil 5mg is effective for BPH symptoms and erectile dysfunction. In head-to-head trials, it’s as good as alpha-blockers for urinary symptoms and better for sexual function [12][13].

One major review found that men taking tadalafil 5mg daily had significant improvements in both lower urinary tract symptoms (LUTS) and erectile function, with most side effects being mild and temporary [14].

Another study showed that combining tadalafil with an alpha-blocker such as tamsulosin can provide even greater relief. However, the risk of mild side effects (such as headache or dizziness) increases slightly [10].

Why do men need better treatment options for BPH?

Many older men have both urinary symptoms—like needing to pee more often or having a weak stream—and erection problems. These issues are common with an enlarged prostate (BPH).

Medicines like alpha-blockers and 5-alpha reductase inhibitors can help with urination but sometimes cause sexual side effects, such as reduced sex drive or problems with ejaculation [10].

What is tadalafil and how does it work?

Tadalafil (best known as Cialis) is usually used for erectile dysfunction (ED), but studies show that taking tadalafil 5mg daily also helps with urinary symptoms caused by BPH. Tadalafil relaxes muscles and improves blood flow in the bladder, prostate, and penis, making it easier to pee and improving erections. Most men find it safe and well-tolerated [10].

Can tadalafil be combined with other medicines?

Some men benefit even more from taking tadalafil 5mg with tamsulosin (an alpha-blocker). This combination often gives better relief from urinary symptoms than either medicine alone.

Mild side effects—such as headache, muscle aches, or dizziness—are a bit more common but usually not serious [10].

If a man stops one of the medicines, the improvement in urinary symptoms usually lasts, but only tadalafil 5mg continues to help with erections [10].

Does tadalafil make urine flow faster?

PDE-5 inhibitors like tadalafil 5mg improve both urinary symptoms and erections, but they don’t usually make urine flow much faster on their own. When combined with an alpha-blocker, they may help urine flow better than an alpha-blocker alone [11].

What do studies say about using these medicines together?

A recent study compared three groups: men taking tamsulosin alone, tadalafil 5mg alone, or both together. All groups improved after 3 months, but the combination group showed the most significant improvement in urinary symptoms and quality of life.

Tadalafil 5mg alone was best for erections, and the combination did better than tamsulosin alone for sexual function.

All treatments improved urine flow and bladder emptying, with the combination showing the largest gains, though differences weren’t always significant. Side effects were mild and mostly seen in the tadalafil and combination groups [12].

Combination therapy: Is more better?

Some men benefit from taking tadalafil 5mg with an alpha-blocker like tamsulosin. This combo can provide extra relief, especially if your symptoms are severe. But it does raise the risk of mild side effects, so it’s best done under medical supervision [10][12].

If you stop one medicine, the improvement in urinary symptoms usually lasts, but only tadalafil continues to help with erections [13].

What about other combinations, like silodosin and tadalafil?

Researchers have also studied silodosin (another alpha-blocker) and tadalafil 5mg 5together. This combination helped men pee more easily, left less urine in the bladder, and improved symptoms more than either medicine alone. However, side effects like headaches, dizziness, and retrograde ejaculation (semen going into the bladder instead of out) were more common with the combination.

Silodosin alone also had more side effects than tadalafil alone, especially for men concerned about fertility. Still, both medicines—alone or together—were generally safe, and most side effects were mild [14].

The bottom line: how does tadalafil 5mg fit in?

Tadalafil 5mg daily, alone or with an alpha-blocker like tamsulosin or silodosin, offers a flexible and effective way to manage both urinary and sexual symptoms in men with BPH. Doctors can tailor treatment to each man’s needs, improving quality of life with relatively few side effects [10][11][12][13][14].

How to take tadalafil 5mg for BPH

Take one tadalafil 5mg tablet at the same time each day, with or without food. It can take a week or two to notice improvements, and up to a month for full effect [5][6].

Don’t take tadalafil if you use nitrate medicines (for chest pain) or certain blood pressure drugs, or if you have severe heart, liver, or kidney problems. Always check with your GP or pharmacist before starting.

What are the side effects?

Most men tolerate tadalafil well. The most common side effects are:

• Headache
• Indigestion
• Back pain or muscle aches
• Flushing
• Stuffy or runny nose

These usually settle within a few hours. Rarely, tadalafil can cause vision or hearing changes, or a prolonged erection (priapism). If you have chest pain, sudden vision loss, or an erection lasting more than 4 hours, seek help straight away [5].

Combining tadalafil with alpha-blockers can increase the risk of dizziness or low blood pressure, so medical supervision is essential [14].

Who is tadalafil 5mg right for?

Tadalafil 5mg is ideal for men with moderate to severe BPH symptoms—especially if you also have ED, or if other treatments haven’t worked or caused side effects [4].

It’s also a good choice if you want a single, once-daily tablet for both urinary and sexual health. If you’re concerned about fertility, tadalafil is less likely than some alpha-blockers to cause retrograde ejaculation [14].

Personalising your treatment: Real-world advice

Everyone’s journey is different. Here’s how to get the most from your treatment:

• Take your tablet daily, at the same time, for steady results.
• Limit fluids before bed to reduce nighttime trips.
• Cut down on caffeine and alcohol.
• Keep active—regular exercise helps with both BPH and ED.
• Eat plenty of fibre to avoid constipation.
• Keep an open dialogue with your GP or pharmacist about side effects or concerns.

And don’t forget: lifestyle changes and medication work best together.

FAQs: Can tadalafil 5mg be used for benign prostatic hyperplasia?

Is tadalafil 5mg approved for BPH?

Yes, the European Commission approved it in 2012 for the treatment of urinary symptoms of BPH, with or without ED [1].

How long does it take to work?

You might notice improvements in a week, but it can take up to a month for the full effect [6].

Can tadalafil be combined with other BPH meds?

Yes, especially with alpha-blockers, but always under medical supervision [10].
Never mix with nitrates or certain blood pressure drugs without checking with your GP.

Is it safe for long-term use?

Yes, studies show it’s generally safe for long-term use, with regular check-ins [5].
Report any unusual side effects straight away.

Will it improve my sex life?

For many men, yes—tadalafil is well-known for improving erections as well as urinary symptoms [7].

Conclusion: The bottom line

Can tadalafil 5mg be used for benign prostatic hyperplasia? Absolutely. It’s a modern, dual-action treatment that addresses both urinary and sexual health in one simple tablet. Backed by substantial evidence, years of experience, and regulatory approval, it’s an excellent option for many men.

As always, talk to your GP or pharmacist to see if it’s right for you. And remember, you’re not alone—help is just a conversation away. If you would like to discuss any points raised in this blog, please contact us.

Disclaimer: This article is for informational purposes only and does not replace professional medical advice.

References

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