What’s the Best Approach to Treating BPH?

There’s no one-size-fits-all approach when you have an enlarged prostate and you’re trying to decide what to do next.

Each person reacts in his own way to the symptoms of benign prostatic hyperplasia (BPH), a common condition for men as they age.

You can talk about your symptoms with your doctor, and together you can decide on the best way for you to handle your case. Your options may include:

Watchful Waiting

If your symptoms don’t bother you much and you haven’t gotten any complications, you may choose to just have you and your doctor keep a regular eye on things.

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

Some things to watch include:

  • Needing to pee a lot
  • The sensation that your bladder is full, even after you’ve just gone
  • An urgent need to go out of the blue
  • A weak stream or dribbling at the end
  • Trouble starting
  • Having to stop and start peeing several times
  • Urine leakage

Reasons to consider watchful waiting for an enlarged prostate:

  • Your symptoms are mild.
  • You don't want the side effects of medications.
  • It’s less costly than medical or surgical treatments.
  • Some men with mild BPH symptoms find they get better without treatment.

If you choose watchful waiting, there are a couple of things you can do to ease things:

Should I Go With a Treatment?

If your symptoms become worse, it's time to talk to your doctor about an active treatment. Some things to ask yourself and your doctor about each option:

  • How much will my condition improve?
  • How long will the effects last?
  • Is there a chance that the treatment will cause problems?

From there, you can talk with him about medications, supplements or surgery.

Continued

Prescription Medications

These may give you relief. Some reasons to consider going on medication for an enlarged prostate include:

  • You have moderate symptoms that aren’t getting better or might be getting worse.
  • You've tried making lifestyle changes, such as drinking fewer liquids, with no results.
  • You are at risk for complications related to BPH, such as not being able to empty your bladder.

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 for an enlarged prostate are:

  • Alpha blockers, which relax muscles of the prostate and neck of the bladder to relieve symptoms. Examples of alpha blocker medications include: Alfuzosin (Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and Terazosin (Hytrin).
  • 5-alpha reductase inhibitors (5-ARIs), which help shrink the prostate and prevent additional growth. Examples of 5 ARIs include: Finasteride (Proscar) and Dutasteride (Avodart).
  • Phosphodiesterase 5 inhibitors (PDE5 inhibitors): Tadalfil (Cialis), Sildenafil, (Viagra), Vardenafil (Levitra).  (PDE5) inhibitors have been shown to improve prostate symptom score with increasing flow rate.

Men with very enlarged prostates may take more than one medication, called combination therapy, to reduce the need for surgery. However, men taking both might also get hit with the side effects of both drugs.

The FDA requires labels on the 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer. Medications that contain 5-ARIs include: dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar).

Supplements

They aren’t as closely regulated as medicines your doctor prescribes. That means their safety, quality, and effects can vary.

Saw palmetto is one of the best-studied and most commonly used supplements to treat BPH. Some small studies have shown benefit. However, several large studies do not show that it reduces the size of the prostate or eases urinary symptoms.
Three others are:

  • Beta-sitosterol
  • Pygeum
  • Rye grass

Talk to your doctor before you start any supplement. They may cause problems with prescription medicines, treatments, or tests you might need.

Procedures

Sometimes BPH doesn't respond enough to lifestyle changes, medications, or supplements. If that's true for you, there are surgical options as well.

You and your doctor look to surgery when you can’t pee at all or have:

One of your options would be what’s called “minimally invasive” surgery. In these types, doctors make much smaller cuts or are able to work with probes they insert through your penis. These types of procedures often mean faster recoveries and less pain and scarring.

Traditional, open surgery is the other option. You should talk with your doctor about what’s best for your case.

WebMD Medical Reference Reviewed by Nazia Q Bandukwala, DO on April 10, 2018

Sources

SOURCES:

Mayo Clinic: “Benign prostatic hyperplasia: Definition” “Benign prostatic hyperplasia: Treatments and Drugs,” “Minimally invasive surgery: Definition.”

Urology Care Foundation: “What Are the Symptoms of BPH?” “Benign Prostatic Hyperplasia (BPH): Surgery,” “BPH: Minimally Invasive Surgeries,” “What is Transurethral Electroevaporation of the Prostate (TUVP)?”

UCLA Health: “Conditions Treated: BPH.”

U.S. Food & Drug Administration: “5-alpha reductase inhibitors (5-ARIs): Label Change - Increased Risk of Prostate Cancer.”

National Institutes of Health, National Center for Complementary and Integrative Health: “Saw Palmetto.”

FDA website. 

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.”

BJU International: “High-grade prostate cancer and finasteride.”

Winchester Hospital: “Health Library: Saw Palmetto”

Casabé A, Roehrborn CG, Da Pozzo LF, et al. "Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia." J Urol.2014;191:727-733

Porst H, Kim ED, Casabé AR, et al. "Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial." Eur Urol.2011;60:1105-1113.

 

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