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.
Alpha-Blockers
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:
- Dizziness
- Fainting
- Headaches
- Lightheadedness
- 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 it because it can lead to birth defects in male babies.
Side effects when men take it 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:
- Dutasteride (Avodart)
- Finasteride (Propecia, Proscar)
Phosphodiesterase-5 Inhibitors
These are the same medicines used to treat erectile dysfunction. They act on smooth muscles in the bladder and prostate, which can help ease BPH symptoms.
Of the several kinds of phosphodiesterase-5 inhibitors, the FDA 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
- Headaches
- Redness and warmth or burning on the face, neck, and upper body
- A stuffy nose
- An upset stomach after eating
- Vision problems
Drug Combinations
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.
Considerations for BPH Treatment
Watchful Waiting
If your symptoms don’t bother you much and you don't have 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 for include:
- Needing to pee a lot
- The sensation that your bladder is full even after you’ve just gone to the bathroom
- 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 monitoring 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 to monitor or observe, there are a couple of things you can do to ease things:
- Make simple changes in your habits. Drinking fewer liquids before bedtime. Drink less caffeine and alcohol generally.
- Avoid some over-the-counter medications. Don't take cold and sinus medicines that have decongestants or certain antihistamines, such as diphenhydramine (Benadryl), that can make a prostate problem worse. Read labels on these products before you buy them.
Supplements for BPH
Supplements 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, BPH treatments, or tests you might need.
BPH Procedures
Sometimes BPH doesn't respond enough to lifestyle changes, medications, or supplements. If that's true for you, there are both minimally invasive procedures and surgical options available.
Your doctor may suggest surgery when you can’t pee at all or have:
- Kidney damage
- Lots of urinary tract infections or bleeding
- Stones in the bladder or urinary retention
With the minimally invasive procedures, doctors make much smaller cuts or are able to work with probes they insert through your penis. These types of treatments often mean faster recoveries and less pain and scarring.
Traditional, open surgery is the other option.
Some studies have shown differences in the way people were treated for their BPH. At least one large study showed Black men were less likely than white and Latino men to have surgery for BHP. Another study showed when men of color did have procedures for BPH, they were inpatient rather than outpatient procedures. Both studies said more research is needed to find out why the differences by race exist and to make sure access to outpatient BPH surgical procedures is more equal.