Does taking Viagra increase your PSA level? No effect on PSA is listed for it. Neither the Australian consumer leaflet for Viagra nor its European product information mentions PSA, and the same is true of Cialis. What can push a PSA result up for a few days is recent ejaculation — whatever led to it — which is why healthdirect suggests avoiding it before the test.
Do the Viagra or Cialis leaflets mention PSA?
No. The Australian Viagra leaflet covers what the medicine is for, who should not take it, the medicines it interacts with and its side effects, and PSA is not among them (Viagra CMI); nor is it in the European product information (EMA — Viagra product information). The Cialis label meets the prostate the other way round: before tadalafil is started for an enlarged prostate, "your doctor will check you for prostate cancer", because the two can have the same symptoms, and "CIALIS does not treat prostate cancer" (EMA — Cialis product information). "Not listed" means the label reports no such effect; it is not a study showing that none exists.
What can raise a PSA level?
Prostate conditions, age and anything that recently disturbed the prostate. PSA is a protein made by the prostate, and most of it goes into semen. healthdirect lists prostatitis, an enlarged prostate (benign prostatic hypertrophy), a urinary tract infection and prostate cancer as causes of a high level, notes that PSA rises gradually with age, and says it "may temporarily increase" after vigorous exercise, recent ejaculation, prostate surgery, anal sex or a prostate examination. "It may be best to avoid ejaculation and vigorous physical activity (such as cycling) in the days before your test" (healthdirect — PSA blood test). So if a PSA test is coming up, the thing to plan around is sex, not the tablet.
Who reads your PSA result?
Your doctor. "A high PSA might be a sign of prostate cancer or another condition" (healthdirect — prostate cancer), and a normal level does not rule cancer out, so healthdirect's advice is that "Your doctor will help you to understand your results". Usually that is your GP, who organises the test: if the level is high for your age, a second test is done 1 to 3 months later, and if it is still high you are referred to a urologist (Healthy Male — prostate cancer). Tell the doctor about recent sex, and about Viagra: its leaflet asks you to "Remind any doctor, dentist or pharmacist you visit that you are taking VIAGRA" (Viagra CMI).
Does Viagra make prostate cancer more likely, or bring it back?
The best evidence so far — a randomised trial and a review of nine studies — has not found that. After prostate cancer treatment, doctors follow the PSA level, because "An increase in PSA may suggest that the cancer is growing" (healthdirect — PSA blood test). In a randomised trial, men were given sildenafil 50 mg or a placebo daily for six months during and after radiotherapy; after a median of 8.3 years of PSA follow-up, the cancer had come back in 5.3% of the sildenafil group and 3.4% of the placebo group, a difference the authors found not significant — though they say the trial was too small to settle the question, and note that "some evidence suggests an increased biochemical recurrence (BCR) risk" in men taking sildenafil after the prostate has been removed (Haseltine et al., J Sex Med 2021). The 2019 review, which pooled nine studies, found that this class of medicine (PDE5 inhibitors) was not linked with a higher risk of prostate cancer, or of the cancer returning after surgery or radiotherapy, and called for better studies to confirm it (Wu et al., Andrologia 2019). If you have been treated for prostate cancer, your urologist or oncologist reads your PSA results.
Can you take Viagra after prostate cancer treatment?
Many men do, because more than 3 in 4 have trouble getting and keeping an erection after surgery, radiation therapy or hormone therapy (healthdirect — prostate cancer). How well it works, and when to start, is in can Viagra be effective after prostate surgery or a biopsy for cancer?, how to overcome erectile dysfunction after prostate surgery and prostate cancer and impotence: causes, recovery and treatment.
What about an enlarged prostate?
An enlarged prostate is one of the causes of a high PSA (healthdirect — PSA blood test). In Australia, Cialis is used for its urinary symptoms as well as for erectile dysfunction (Cialis CMI). More in can Cialis help with an enlarged prostate?, can Viagra be used to treat an enlarged prostate or BPH? and how is an enlarged prostate linked to erection problems?
The short answer
No Australian or European leaflet for Viagra or Cialis lists any effect on PSA. Ejaculation and vigorous exercise can raise PSA for a few days, so avoid them before the test, and let your GP — or, after cancer treatment, your urologist or oncologist — read the result. Pooled studies have not linked ED tablets with prostate cancer or its return. Every question about operations and erections is in our guide to erectile dysfunction after surgery.
