Not too long ago, men who wanted relief from BPH had one main option: surgery. In recent years, that’s changed. Drugmakers have come out with a number of medicines that give you more choices to treat your symptoms.
Benign prostatic hyperplasia (you’ve probably heard it called enlarged prostate) can cause problems such as a weak urine stream or having to pee a lot all day. Some medicines ease these symptoms by calming the muscles in the bladder and prostate. Others stop prostate growth and shrink the size of the prostate.
Medicine is now the most common way to treat men with mild to moderate BPH. Researchers are still learning about long-term effects and when drugs can be most helpful. Talk to your doctor to find out which medicine may be best for you.
These work by relaxing muscles in your bladder and prostate, which makes it easier to pee. They don’t change the size of your prostate, but they do help with urine flow, waking at night to pee, and other symptoms. And you won’t have to wait long to see results; they usually work right away.
If you have high blood pressure and BPH, alpha blockers may be a good option for you because they treat both conditions.
If you are planning to have cataract surgery, it’s best to avoid them. They can lead to problems during the procedure.
Side effects: Since alpha blockers affect your blood pressure, they can make you feel very tired and cause these other things as well:
- Low blood pressure
They may also lead to what you may hear a doctor call “retrograde ejaculation.” This is when sperm go backward into your bladder instead of out through your penis. It doesn’t cause any harm, but it means you may not have any sperm when you ejaculate. Men who still want to have children should keep this in mind.
Names: Your doctor might suggest one of these alpha blockers:
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura)
- Prazosin (Minipress)
- Silodosin (Rapaflo)
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
5-Alpha Reductase Inhibitors
These stop your body from creating one of the hormones that makes your prostate larger. They prevent growth and in some cases even shrink it. This can improve your urine flow and ease other BPH symptoms as well. They seem to be most helpful to men with very large prostates.
These drugs have two other benefits as well. They may:
- Lower the odds that BPH will lead to other problems, such bladder damage
- Make you less likely to need surgery
- It can take up to 6 months to see the full effects of 5-ARIs, and you have to keep taking them to get results.
Side effects: This medication is not for use by women. Pregnant women should not be exposed to itbecause it can lead to birth defects in male babies.
Other side effects when men take it may include:
- Erectile dysfunction
- Lower sex drive
- Retrograde ejaculation
Some of these side effects may get better as your body gets used to the medicine.
5-ARIs may also lower your PSA (prostate-specific antigen), which affects one way that doctors look for prostate cancer. That isn’t harmful, but it may help to get a PSA test before starting these drugs. Also, the FDA now requires labels on 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer.
Names: There are two main 5-alpha reductase inhibitors:
- Finasteride (Propecia, Proscar)
- Dutasteride (Avodart)
These are the same medicines used to treat erectile dysfunction. They smooth muscles in the bladder and prostate, which can help ease BPH symptoms.
There are several kinds of phosphodiesterase-5 inhibitors, but the Food and Drug Administration has approved only Tadalafil (Cialis) to treat BPH.
It’s not used as often as other drugs, but if you have ED and BPH, it’s another option.
Side effects: When you take Cialis, you might get:
- Back and muscle pain
- Redness and warmth or burning on the face, neck, and upper body
- A stuffy nose
- An upset stomach after eating
- Vision problems
If one medication on its own doesn’t help with symptoms, your doctor may suggest taking two. Common combinations include:
- Finasteride and doxazosin
- Dutasteride and tamsulosin — this comes in a single pill (Jalyn)
- Alpha blockers and antimuscarinics (drugs used to treat overactive bladder)
While these combos can be more helpful than a single drug, they may also result in more side effects, since you’re taking two medications instead of one.
- PubMed: “Various treatment options for benign prostatic hyperplasia: A current update.”
- Mayo Clinic: “Benign Prostatic Hyperplasia (BPH).”
- Johns Hopkins: “Benign Prostatic Hyperplasia.”
- Urology Care Foundation: “Benign Prostatic Hyperplasia (BPH).”
- Merck, “Highlights of Prescribing Information: Propecia.”
- American Academy of Ophthalmology: “Alpha-Blocker Patient Advisory ASCRS and AAO Information Statement.”
- NHS: “Treating Benign Prostate Enlargement.”
- NIH, National Institutes of Diabetes and Digestive and Kidney Diseases: “Prostate Enlargement: Benign Prostatic Hyperplasia.”
- Medscape: “Benign Prostatic Hypertrophy Treatment & Management.”
- FDA: “Questions and Answers for Cialis (tadalafil).”