When lifestyle changes are not enough to control urinary symptoms, tablets are usually the next step. Two main types of medicine are used for an enlarged prostate. They work in different ways, and some men take both. Understanding each one helps you know what to expect and when to ask for a review.
Alpha blockers
Alpha blockers relax the smooth muscle in the prostate and at the neck of the bladder. This eases the squeeze on the urethra and lets urine flow more easily. They do not shrink the prostate.
Common examples include tamsulosin, alfuzosin and doxazosin.
How quickly they work: usually within days to a couple of weeks. Most doctors review the effect after four to six weeks.
Possible side effects:
- dizziness, especially when standing up quickly
- tiredness
- a blocked or runny nose
- reduced or absent ejaculation, which is harmless but can be unexpected
If you are planning cataract surgery, tell your eye surgeon you take an alpha blocker, as it can affect the iris during the operation.
5-alpha reductase inhibitors
These medicines block the conversion of testosterone into a more powerful hormone called DHT, which drives prostate growth. Over time, the prostate shrinks, usually by about a quarter.
The two main examples are finasteride and dutasteride.
How quickly they work: slowly. It can take three to six months to notice a benefit, and up to a year for the full effect. They work best in larger prostates.
Possible side effects:
- reduced sex drive
- erection problems
- reduced volume of ejaculate
- breast tenderness or enlargement, less commonly
These medicines also lower PSA by around half. If you take one, your doctor will allow for this when interpreting a PSA test.
Combination treatment
For men with larger prostates and moderate to severe symptoms, taking an alpha blocker and a 5-alpha reductase inhibitor together can work better than either alone. Combination treatment can reduce the risk of urinary retention and the need for surgery. NICE guidance on urinary symptoms in men sets out when this is recommended.
Other medicines
Depending on your symptoms, your doctor may also suggest:
- Medicines for an overactive bladder: to reduce urgency and frequency, used with care if the bladder does not empty well.
- Tadalafil: a medicine also used for erection problems, which can ease urinary symptoms in some men.
- Desmopressin: for men who produce too much urine at night, in selected cases.
How long to take them
BPH medicines treat symptoms but do not cure the condition. If you stop, symptoms usually return. Many men take them for years. Regular reviews check that they are still working and that side effects are manageable. If side effects bother you, tell your doctor. There is often an alternative medicine or a different dose to try, and some side effects, such as dizziness, tend to ease after the first few weeks.
When medication is not enough
Medication may not be the right long-term answer if:
- symptoms remain troublesome despite treatment
- side effects are hard to live with
- you would prefer not to take tablets indefinitely
- there are signs of bladder strain, such as retention or infections
In these cases, a procedure may be considered. Options such as Aquablation therapy and iTind aim to relieve symptoms with a lower risk of sexual side effects than older operations. Our guide to lifestyle changes for prostate symptoms explains what to keep doing alongside any treatment. The NHS guide to an enlarged prostate also covers the options.
Professor Prokar Dasgupta can review your current medicines and discuss whether other treatments might suit you at The London Clinic. Please contact the clinic to arrange a consultation.