Treatment and Drug Options for Prostate Enlargement

Treatments for BPH have advanced significantly over the past thirty years

Elderly man taking daily medicine
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An enlarged prostate, known as benign prostatic hypertrophy, or BPH, affects primarily men over 50 years of age. The condition is not usually life-threatening, but it can cause problems with urination.

The type of treatment needed for prostate enlargement depends on the severity of the signs and symptoms being experienced. Bleeding from the urinary system, serious urinary infections, or frequent urination that impact lifestyle or cause discomfort may indicate that active medical intervention is required.


Drug Treatments for Prostate Enlargement

There are two types of medication that help to control the symptoms of an enlarged prostate: alpha blockers and 5-Alpha-reductase inhibitors. 

Alpha blockers are effective in about 75 percent of men. They work by relaxing the muscles at the neck of the bladder, making urination easier. The FDA has approved the following alpha blockers:

  • Cardura (doxazosin)
  • Flomax (tamsulosin)
  • Hytrin (terazosin)
  • Rapaflo (silodosin)
  • Minipress (prazosin1)
  • Uroxatral (alfuzosin)

You should see improvements within one or two days of starting treatment. Side effects can include dizziness and tiredness — and in some people, low blood pressure upon standing, as well as impotence.

5-Alpha-reductase inhibitors actually shrink the prostate gland and are found to be most effective in men whose prostate is significantly enlarged. It can take a long time for the drug to show improvement in symptoms—sometimes up to a year for complete results.

The 5-alpha-reductase inhibitors include:

  • Avodart and Jalyn (dutasteride)
  • Proscar and Propecia (finasteride)

Side effects can include a reduced libido, impotence and reduced semen release during ejaculation. Proscar and Propecia also have the side effect of hair growth, and are sometimes used for treating male pattern baldness.

Herbal Alternatives for Prostate Enlargement

Serenoa repens, known as saw palmetto, has been widely tested, and results are promising. It is thought to work by preventing testosterone from breaking down into another form of the hormone associated with prostate tissue growth.

In 1998, researchers at the Department of Veterans Affairs reviewed more than a dozen studies involving Serenoa repens. It found Serenoa repens to be as effective as Proscar or Propecia in reducing the size of an enlarged prostate, and it produced fewer side effects. The herbal alternative seems to work slowly, with improvement in urinary symptoms within 1 to 3 months. If no improvement is seen after that time, then the herb should be discontinued. Additional research is required to determine the appropriate daily dosage of the supplement, and its long-term effectiveness.

Many conventional drugs have a herbal basis, so just because we associate herbs with health doesn't mean they're necessarily "better" for you. Remember: As with many herbal products, Serenoa repens may suppress prostate specific antigen (PSA) levels in your blood, which can interfere with the effectiveness of the PSA test used to detect prostate cancer, so it's important to tell your doctor before having a PSA test.

Heat Therapies for Prostate Enlargement

Heat, delivered through the urethra and using a local anaesthetic can be used to reduce the size of the prostate. Usually carried out on an out-patient basis, results should be quick and recovery from the procedure typically takes a few days. Available types of heat therapy include Electro vaporization, microwave therapy or laser therapy.

Surgical Options for Prostate Enlargement

Surgical intervention is now less common because of effective and less invasive alternative therapies. Surgery is often the most effective long-term option for difficult-to-manage or more serious complications resulting from an enlarged prostate.

There are a number of surgical procedures for an enlarged prostate:

All of these procedures require hospital in-patient care, a general anaesthetic and time off work. Side effects can arise from infection or nerve or structural damage, and can include loss of bladder control, impotence and problems with ejaculation.

Other treatment options include prostate stents and balloon dilation, which are good for men who are unable to tolerate other forms of treatment.

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