Treatments for BPH

Many men don’t think to ask about treatments for BPH because they assume the treatments will lead to compromises in their quality of life, including sexual function. Treatment is strongly recommended for BPH symptoms that interrupt your life. If BPH is left untreated, it can lead to future health risks, such as the inability to urinate, urinary tract infections, bladder, kidney, or urethra damage, bladder stones, and incontinence

What are the treatment options?

Treatment options include active surveillance (sometimes called watchful waiting), drug therapy and surgery.

What is active surveillance (watchful waiting)?

Active surveillance (watchful waiting) means keeping an eye on the BPH symptoms without receiving any form of treatment. For men with minimal to mild BPH symptoms that do not interfere with daily routines, this may be a preferred choice. As part of watchful waiting, men continue to have annual examinations to determine if their symptoms change over time.[1]

What kinds of medications are used to treat BPH?

Drugs called alpha-blockers are the most common treatment prescribed to manage BPH symptoms. By relaxing the muscles around the prostate so that there is less pressure on the urethra, alpha-blockers usually work quickly to improve urinary flow. Common side effects can include stomach or intestinal problems, a stuffy nose, headache, dizziness, tiredness, a drop in blood pressure and ejaculatory problems.

Alpha-blockers include Cardura® (doxazosin mesylate), Flomax® (tamsulosin hydrochloride), Hytrin® (terazosin hydrochloride), and Uroxatral® (alfuzosin hydrochloride).[2]*

Another type of drug, called a 5-alpha-reductase inhibitor, is also sometimes prescribed. Designed to shrink the prostate gland, it may take three to six months to effectively relieve symptoms. Side effects may include an inability to achieve an erection, decreased sexual desire and a reduced amount of semen. Examples of 5-alpha reductase inhibitors are Avodart™ (dutasteride) and Proscar® (finasteride).[3]^**

No matter what kind of drug is prescribed, patients and physicians need to be aware of potential drug interactions with treatments used to manage other conditions common among aging men, such as erectile
dysfunction and hypertension.

There are also various combination therapies available, such as an alpha blocker with a 5-alpha-reductase inhibitor and an alpha blocker and a drug called an anticholinergic. Talk with your healthcare provider to determine which treatment option may be appropriate for you.

What are other BPH treatment options?

Surgery is usually used only in those patients with major BPH complications such as frequent urinary tract infections or bladder stones. There are several non-surgical approaches that use heat therapy to make the size of the prostate smaller. This will widen the urethra so you can urinate easily again. These heat treatments include microwave therapy, radiofrequency therapy, electrovaporization, and laser therapy. In the most extreme cases, open surgery may be required.[4]

Surgery treats BPH symptoms by reducing the size of the prostate, but it does not prevent the cause of the disorder; surgery might need to be repeated within a few years. Side effects of surgery may include urgency and frequency of urination for some period after surgery, difficulty in achieving an erection, blood in your urine, blood clots, sexual dysfunction, recurring urinary tract infections, inability to hold your urine (incontinence) or a narrowing of the urethra (scarring).

If BPH is left untreated, an enlarged prostate may lead to an inability to urinate, incontinence, bladder stones, kidney infections, or damage to the bladder, kidneys, and urethra.

*Cardura is a registered trademark of Pfizer Inc
Flomax is a registered trademark of Astellas Pharma
Hytrin is a registered trademark of Abbott Laboratories
Uroxatral is a registered trademark of Sanofi Synthelabo Inc.
Rapaflo is a trademark of Allergan-Actavis.
**Avodart is a trademark of GlaxoSmithKline
Proscar is a registered trademark of Merck and Co., Inc.

Please note: Men’s Health Network does not provide medical services. Rather, this information is provided to encourage you to begin a knowledgeable dialogue with your physician. Check with your health care provider about your need for specific health screenings.

[1] American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). P9. Revised 2010.
[2] American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). P 8-10. Revised 2010.
[3] American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). P8, 14-15. Revised 2010.
[4] NIH Publication No. 14-3012. Prostate Enlargement: Benign Prostatic Hyperplasia. P 9-14. August 2014.
[5] NIH Publication No. 14-3012. Prostate Enlargement: Benign Prostatic Hyperplasia. P 14. August 2014.