If your your doctor suggests that you start on medication to treat your enlarged prostate, it probably means that your symptoms are bothersome and are unlikely to resolve with time. It could also mean that they are so severe that you can't tolerate them, or that they are resulting in a back-up of urine. Experts, however, caution against rushing into starting BPH medication before it is needed.
According to the National Institutes of Diabetes, Digestive, and Kidney Disorders and others, many researchers have challenged early treatment for BPH because up to one-third of patients have their symptoms resolve without treatment. The American Urological Association also advises considering a trial of watchful waiting if you are not bothered by your symptoms, and your symptoms are not resulting in other urinary tract problems.
That said, if your symptoms feel bothersome, you should discuss trying medical treatment (the least invasive form appropriate for your situation) with your urologist.
There are several types of drugs that act differently in reducing BPH symptoms. According to the American Urological Association, no drug in a given class is better than the other.
Alpha blockers relax the muscles of the prostate and bladder neck, relieving the signs and symptoms of BPH. Alpha blockers provide only modest symptom improvement and because of that, they tend to be used for patients with mild symptoms.
Four alpha blockers are on the market in the United States:
- Cardura (doxazosin)
- Flomax (tamsulosin)
- Hytrin (terazosin)
- Uroxatral (alfuzosin)
If your urologist prescribes an alpha blocker, expect to be monitored in the first few weeks to check for symptom improvement, optimal dosage, and development of any side effects. Each of these drugs has known side effects, but they vary from drug to drug (see links for each above). If you start having stomach or intestinal problems, sinus congestion, headache, or dizziness, contact your doctor immediately.
5-alpha reductase enzyme inhibitors work by shrinking the prostate. If successful, they can help prevent you from retaining urine and avoid surgery at a later time.
5-alpha reductase inhibitors used for BPH include:
- Proscar or Propecia (finasteride)
- Avodart (dutasteride)
It takes 3 to 6 months before you gain symptom relief, according to the American Urological Association. Side effects include erectile dysfunction, decreased libido, and lower semen production.
The best candidates for combination therapy are men with large prostates and high PSA levels. An alpha blocker is combined with a 5-alpha-reductase inhibitor. This provides the combined benefit of relaxing the prostate (from the alpha blocker) and shrinking it (from the 5-alpha-reductase inhibitor). If your symptoms are quite bothersome, this might be an attractive first-line treatment option for you.
A large study of more than 3000 men compared the effects of placebo, an alpha blocker, a 5-alpha-reductase inhibitor, or combination therapy on the progression of BPH. Combination therapy showed a 66% reduction in risk, far greater improvement than 34% with an alpha blocker alone, and 39% with a 5-alpha-reductase inhibitor.
Combination therapy is not without side effects. Men may develop side effects associated with each drug in the combination.
Plant and Plant Extracts
Use of alternative therapies for prostate health has been extremely popular around the world. The most widely used plant extract is saw palmetto. According to a landmark clinical trial on the use of saw palmetto that was published in the New England Journal of Medicine, saw palmetto did not improve BPH symptoms when evaluated by the men themselves or using objective follow-up tests. Even though no studies to date have shown a benefit for saw palmetto, men continue to purchase it at health food and supplement stores.
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Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, et al. Combination therapy with doxazosin and finasteride for benighn prostatic hyperplasia in patients with lower urinary tract symptoms anda baseline total prostate volume of 25 ml or greater. J Urol 2006 175(1):17-20.
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