The mainstays of treatment for BPH are drugs or surgery. However, some men with mild symptoms opt for watchful waiting, where no treatment is undertaken but instead your condition will be monitored closely with routine check-ups. If your condition deteriorates you can then opt for treatment.
There are two main classes of drugs that are prescribed for BPH:
- Five alpha reductase inhibitors (often written 5 alpha-reductase inhibitors)
Alpha-blockers work by relaxing the muscles at the neck of the bladder and in the prostate. In this way they reduce the pressure on the urethra and so help increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms. Around 60% of men find their symptoms improve significantly within the first 2-3 weeks of treatment with an alpha-blocker. There are several different five alpha blockers. Currently, these are doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Xatral) and prazosin (Hypovase). They can also be used to treat high blood pressure. The most common side-effects of alpha-blockers are tiredness, dizziness and headache.
5 alpha-reducatase inhibitors work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement. Finasteride (Proscar) is the mostly commonly used drug of this type for BPH. Unlike alpha blockers, 5 alpha-reductase inhibitors are able to reverse BPH to some extent and so may delay your need for surgery.
Potential side-effects of finasteride include a reduced sex drive and difficulty in maintaining an erection. Several months of treatment may be needed before improvement is noticed.
A range of plant extracts claim to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial and it is a popular treatment for BPH, especially in Germany. If you decide you want to try a plant remedy, it’s always best to discuss this first with your doctor or pharmacist as interactions with conventional medicines are possible.