After years of success, saw palmetto stopped working for me. My urologist preferred Cialis (tadalafil) over Flomax, and b/c it is usually prescribed for ED, it will actually lessen sexual dysfunction and improve with 10mg (safe for a daily dose). My experience with both Levitra and Viagra gave me headaches and increased my BP. Maybe consider going off the SP for a while to see if Cialis alone might help?
Good Luck