When watchful waiting (the close monitoring of BPH symptoms without seeking treatment), is no longer desirable or feasible, BPH medication is often considered the next step for treating an enlarged prostate. Medications to treat BPH are necessary when prostate symptoms are no longer tolerable under watchful waiting and surgery isn’t yet desired. Alpha-blockers are considered the first-line treatment for prostatic hyperplasia when considering common BPH medications. Even though BPH medicines have side effects, addressing lower urinary tract symptoms (LUTS), which are brought on by benign prostatic hyperplasia or BPH, is important. The best medication for BPH depends on the individual, the type of BPH symptoms, and the medication that is actively taken and not missed. BPH medications can help some men deal with their BPH symptoms for a while, or even long-term, depending on the circumstances, their degree of discomfort or inconvenience, their health, the type of BPH, and the size of their prostate tissue.
The anatomy of the prostate consists of several zones, including the peripheral, central, and transition zones, and multiple anatomical lobes, including the anterior and posterior lobes, two lateral (left and right) lobes, and the median (inside) lobe.
Overgrowth of the two lateral lobes is the primary contributing factor to benign prostatic hyperplasia for most men. These men typically respond better to BPH medication versus men who not only experience expansion of the lateral lobes, but also an increase in the size of their median lobe and its likely incursion up into the bladder.1 This situation usually leads to more severe BPH symptoms since the median lobe can act like a ball valve and at times completely block urine passage out of the bladder. Men with median lobe overgrowth, more often than not, don’t respond to BPH medication at all or only for a limited time.1
BPH medication is the most popular treatment for men with an enlarged prostate and mild to moderate BPH symptoms, but it doesn’t work for everyone as mentioned above. It is, however, the next step in the process of trying to treat BPH symptoms for many men before they consider surgery. BPH medication can be the bridge between watchful waiting and surgery, but there are side effects to BPH medication that have to be weighed as part of a BPH treatment plan that takes into account the most effective, yet safest route to benign prostatic hyperplasia relief.
Classes of BPH Medication
Two primary classes of prescription medication (alpha-blockers and 5-alpha reductase inhibitors) that treat BPH symptoms are available to men when watchful waiting is no longer viable and surgery isn’t yet being considered.
Alpha-BlockersCommon BPH medications such as Tamsulosin (Flomax), Alfuzosin (Uroxatral), or Silodosin (Rapaflo) are effective for some men because they relax the muscles of the bladder and prostate, which in turn makes it easier to urinate. They begin to work immediately and if high blood pressure is also a concern, alpha-blockers can treat both issues. However, alpha-blockers may not help everyone. Men with an enlarged median lobe tend not to respond as well to alpha-blockers since the prostate’s median lobe can favor growing up into the bladder and block urine flow like a ball valve, preventing urinary flow from even beginning in severe cases. Some minor to potentially undesirable side effects can accompany alpha-blockers and the medication needs to be taken regularly for benefits to continue.
5-Alpha Reductase Inhibitors (5-ARI’s)These types of medications to treat BPH suppress the ability of the 5-alpha reductase enzyme, which is present in the skin, liver, and prostate, to turn testosterone into dihydrotestosterone (DHT). DHT plays an important role in prostate tissue growth. If preventing additional prostate growth and even shrinking the prostate is desirable, then 5-alpha reductase inhibitors like Finasteride (Propecia and Proscar) or Dutasteride (Avodart) may be an option. However, they can take up to six months to begin addressing benign prostatic hyperplasia and providing benefits. They can come with unwanted side effects for some men and the medication needs to be continued for results to continue.
A BPH medication variation, which combines the two classes listed above, is also available to men who need relief from BPH symptoms immediately, but who also want to shrink the prostate long term. Sometimes men are placed on the combo regimen when one class of medication is not working enough on its own to address benign prostatic hyperplasia.
Combination BPH MedicationsA combination of an alpha-blocker and a 5-alpha reductase inhibitor may be prescribed by a doctor if one or the other isn’t providing relief for the enlarged prostate by itself. Also, when immediate BPH symptom relief is needed and long-term prostate tissue size reduction is desired, a combination protocol can be advantageous.
A third medication class (phosphodiesterase inhibitors), which includes Sildenafil (Viagra) and Tadalafil (Cialis) may help men with BPH symptoms, but studies performed so far are inconclusive on how beneficial the benefits may be.
BPH medication can be effective for many men both short and long-term, but for some men, the benefit never materializes. Most men will need to remain on BPH medication for life (indefinitely) unless it stops working or they opt for surgery. This is because BPH medication only works as long as it is administered regularly. Once it is no longer taken, BPH symptoms return either immediately or after a while when the prostate commences its growth.
Medications to avoid if you have BPH include anything that can cause urine retention or worsen BPH symptoms. Decongestants like pseudoephedrine, which is found in cold medicine, or Benadryl, which is an antihistamine, have been found to potentially worsen BPH symptoms.
BPH Medication Side Effects
BPH medication can make a big difference for some men experiencing LUTS brought on by benign prostatic hyperplasia. It can be a temporary or permanent bridge between watchful waiting and possible surgery, depending on the individual. For other men, especially men who experience excess median lobe growth, BPH medication may not work as well or at all. In either case, men should be aware of the common side effects of BPH medications to treat benign prostatic hyperplasia. That way an educated decision can be made whether to take BPH medication or opt for a surgical procedure. Some of the more common side effects of both primary classes of BPH medication are listed below.
Alpha-Blockers – Since alpha-blockers obstruct or block alpha1 adrenoreceptors (proteins that aid in muscle contraction) to relax the smooth muscles of the prostate, bladder neck, veins, and arteries, they can cause some corresponding side effects that are ok for some men, but a deal breaker for others. These medications can be lifelines in addressing benign prostatic hyperplasia but do come at a potential health cost. Ten of the more common potential alpha-blockers’ side effects are:2,3,4
- Orthostatic hypotension (drop in blood pressure when starting to stand up)
- Nasal congestion
- Retrograde ejaculation
- Dysfunctional ejaculation
5-Alpha Reductase Inhibitors (5-ARI’s) – Also known as dihydrotestosterone (DHT) blockers and alternatively used to treat male pattern hair loss, this class of BPH medication works to block DHT formation and decrease the size of the prostate. As with any medication, there are side effects, and some can be life-altering, so it is up to men and their doctors to decide whether the possible benefits outweigh the possible side effects. Benign prostatic hyperplasia can be pervasive, so these medicines have been designed to help men with their BPH symptoms. Ten of the more common potential 5-Alpha Reductase Inhibitors’ side effects are listed below.5
- Decreased sex drive
- Ejaculatory disorder
- Erectile dysfunction
- Elevated high-grade prostate cancer risk
- Gynecomastia (breast tissue enlargement in men)
- Increased hair growth
For treating benign prostatic hyperplasia symptoms, BPH medication is typically the next step taken by men after watchful waiting has run its course and prostate surgery isn’t yet desired or deemed necessary. It is either the intermediate step for some men suffering from an enlarged prostate or the final therapy needed for others. BPH medication can address a good portion or all BPH symptoms for some men, but others may not respond at all or minimally to the treatment.
BPH medication comes with probable trade-offs in the form of side effects that could be acceptable to some men, but not others. BPH medication for decreasing or eliminating enlarged prostate tissue due to benign prostatic hyperplasia includes side effects that can potentially affect one’s health, both short-term and longer-term, and should be evaluated for both benefits and risks before they are taken to relieve BPH symptoms.
- Alex Shteynshlyuger MD https://www.newyorkurologyspecialists.com/bph/median-lobe/
- Nachawati D, Patel JB. Alpha Blockers. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island(FL):StatPearlsPublishing;2022Jan.
- Kaplan SA. Side Effects of alpha-Blocker Use: Retrograde Ejaculation. Rev Urol. 2009 Fall;11(Suppl 1):S14-8. PMID: 20126607; PMCID: PMC2812888.
- Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review. J Clin Aesthet Dermatol. 2016 Jul;9(7):56-62. Epub 2016 Jul 1. PMID: 27672412; PMCID: PMC5023004.
All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.