Drug therapies

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BPH Treatments - Medication

There are effective treatments available for prostate gland enlargement, including medications, minimally invasive therapies and surgery.

To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have, and your preferences.

The primary categories of treatment options are:

Please see below for more information on medical or drug therapies for BPH symptoms.

This information is not intended to be an exhaustive list of all possible treatments for an enlarged prostate, but presents common therapy options for your information.

Medicine is one of the most common ways to treat men with mild to moderate BPH symptoms.

Alpha Blockers for BPH Symptoms

How do Alpha Blockers Work for BPH?

These pills relax the muscles of the prostate and bladder to improve urine flow. They reduce symptoms of BPH and blockage of the urethra. The pills do not reduce the size of the prostate. Alpha blockers work almost immediately and provide much relief for urinary problems.

If you have high blood pressure and BPH, alpha blockers may be a good option for you because they treat both conditions.

Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.

The CUA includes alpha blocking drugs as a recommended option in the 2018 guideline on male lower urinary tract symptoms/benign prostatic hyperplasia, which states:

Alpha-blockers Alfuzosin, doxazosin, tamsulosin, terazosin, and silodosin are appropriate treatment options for LUTS secondary to BPH. Doxazosin and terazosin require dose titration and blood pressure monitoring.

Alpha-blockers do not alter the natural progression of the disease (little impact on prostate growth, the risk of urinary retention or the need for BPH-related surgery). The most common adverse effect associated with alpha-blockers is dizziness (2–10%, with the highest rates for terazosin and doxazosin), while ejaculatory disturbances are most often reported with tamsulosin and silodosin.

Floppy iris syndrome has been reported in patients on alpha-blockers, particularly tamsulosin, but this does not appear to be an issue in men with no planned cataract surgery and can be managed by an ophthalmologist, who is aware that the patient is on the medication.

Although there are differences in the adverse event profiles of these agents, all five agents appear to have equal clinical effectiveness. The choice of agent should depend on the patient’s comorbidities, side effect profiles, and tolerance. We recommend alpha-blockers as an excellent first-line therapeutic option for men with symptomatic bother who desire treatment (strong recommendation based on high quality evidence).

Since alpha blockers affect your blood pressure, they can make you feel tired and cause dizziness, headaches, and low blood pressure. Some alpha blockers might have what’s called a “first-dose effect.” When you start taking an alpha blocker, you might develop pronounced low blood pressure and dizziness, which can make you faint when you rise from a sitting or lying position. As a result, the first dose is often taken at bedtime. Other side effects might include:
  • Headache
  • Pounding heartbeat
  • Weakness
  • Dizziness
  • Weight gain

On the positive side, alpha blockers might decrease low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol). Alpha blockers can increase or decrease the effects of other medications you take. Before taking an alpha blocker, be sure your doctor knows about other medications you take, such as beta blockers, calcium channel blockers or medications for erectile dysfunction.

5-Alpha Reductase Inhibitors

How do 5-Alpha Reductase Inhibitors Treat BPH

These pills block the body’s production of dihydrotestosterone (DHT) which has been considered to be a factor in prostate enlargement. These pills are particularly effective for men with prostates that have grown so large they are imposing on the bladder or urethra.

These drugs may lower the risk that BPH will lead to other problems like bladder damage, and reduce the chances that you will eventually need a surgical procedure to reduce the prostate. 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.

Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.

The CUA includes 5-alpha reductase inhibitors as a recommended option in the 2018 guideline on male lower urinary tract symptoms/benign prostatic hyperplasia, which states:

Several studies have demonstrated that 5ARI therapy, in addition to improving symptoms and causing a modest (25–30%) shrinkage of the prostate, can alter the natural history of BPH through a reduction in the risk of acute urinary retention (AUR) and the need for surgical intervention.

Efficacy is noted in patients with a prostate volume >30 cc (and/or PSA levels >1.5 ng/ml). 5ARI treatment is associated with erectile dysfunction, decreased libido, ejaculation disorders, and rarely, gynecomastia.

We recommend 5ARIs (dutasteride and finasteride) as appropriate and effective treatment for patients with LUTS associated with demonstrable prostatic enlargement (strong recommendation based on high-quality evidence).

Men taking these meds may experience erectile dysfunction, a lower sex drive, or retrograde ejaculation.Side effects might include:
  • Dizziness
  • Retrograde ejaculation – a harmless condition in which semen goes back into the bladder instead of out of the penis.
  • Weak erections
  • Loss of interest in sex
  • Low blood pressure

Some of these side effects may get better as your body gets used to the medicine.

Additional BPH Treatments

Lifestyle Factors

To help control the symptoms of an enlarged prostate, you can:

  • Limit beverages in the evening. Don’t drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
  • Limit caffeine and alcohol. They can increase urine production, irritate the bladder and worsen symptoms.
  • Limit decongestants or antihistamines. These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
  • Go when you first feel the urge. Waiting too long might overstretch the bladder muscle and cause damage.
  • Schedule bathroom visits. Try to urinate at regular times — such as every four to six hours during the day — to “retrain” the bladder. This can be especially useful if you have severe frequency and urgency.
  • Follow a healthy diet. Obesity is associated with enlarged prostate.
  • Stay active. Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
  • Urinate — and then urinate again a few moments later. This practice is known as double voiding.
  • Keep warm. Colder temperatures can cause urine retention and increase the urgency to urinate.