BPH: Should You Choose Watchful Waiting or Medication?

Reviewed by Brunilda Nazario, MD, March 2006

Each man has a different tolerance for symptoms of benign prostatic hyperplasia (BPH), also known as enlarged prostate. If your symptoms are not bothering you greatly -- and you have not developed any urinary complications -- you may choose watchful waiting as your treatment strategy.

This means seeing your doctor once a year -- or sooner if your symptoms change.

Watchful Waiting for Enlarged Prostate

If you choose watchful waiting, there are things you can do to reduce your symptoms:

• Make simple changes in your habits, like drinking fewer liquids before bedtime - and drinking less caffeine and alcohol generally.
• Don't take over-the-counter cold and sinus medicines with decongestants, which can make a prostate problem worse.
• Talk to your doctor about taking saw palmetto or another herbal supplement to improve the symptoms of BPH. Keep in mind that, like other herbal remedies, Saw palmetto is an herbal therapy that is not FDA-approved. The safety and effectiveness of herbal therapies are not well-studied.

Watchful waiting is the least invasive treatment for enlarged prostate. You avoid the risks and costs of medications, procedures, and surgery. For some men, mild BPH symptoms improve with time. If symptoms become worse, it's time to talk to your doctor about treatment.

BPH and Prescription Medications

When enlarged prostate symptoms become more bothersome, medications may help provide relief. Two types of medications are available to treat moderate BPH. Each works differently in the body, and each has its own side effects.

The two classes of drugs are:

• Alpha blockers, which relax muscles of the prostate and bladder neck to relieve symptoms.
• 5-alpha reductase inhibitors, which help shrink the prostate and prevent additional growth.

Men with very enlarged prostates may take both types of drugs, called combination therapy, to reduce the need for surgery. However, men taking combination therapy may experience the side effects of both drugs.

How to Decide on Your BPH Treatment

The choice between watchful waiting and taking medications is something to be discussed with your doctor. Together, you must weigh the risks and benefits of each.

Ask yourself about each option:

• How much is my quality of life affected right now?
• How much will it improve?
• How long will the effects last?
• Is there a risk that the treatment will cause problems?

Points to Consider in Treating Enlarged Prostate

Reasons to use medication:

• You have moderate, bothersome BPH symptoms.
• You have tried watchful waiting, but symptoms are still bothersome.
• You've tried making lifestyle changes, like drinking fewer liquids.
• You are at risk for complications related to BPH, like urinary retention.

Reasons to try watchful waiting:

• Your BPH symptoms are mild and not bothersome.
• You don't want the side effects of medications.
• It's less costly than medical or surgical treatments.
• From one-third to one-half (31% to 55%) of men with mild symptoms find that symptoms improve without treatment.
• You must take medications indefinitely to control BPH symptoms.

Published March 2006.

SOURCES: American Urological Association: "Benign Prostatic Hyperplasia (BPH): A Patient's Guide," "Benign Prostatic Hyperplasia (BPH)," "Clinical Guidelines." Agency for Healthcare Policy Research. William Jaffe, MD, professor of urology, Temple University School of Medicine, Philadelphia. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC): "Prostate Enlargement: Benign Prostatic Hyperplasia."