Enlarged Prostate: Should I Take Medicine?

Benign prostatic hyperplasia, or BPH, is better known as an enlarged prostate. It happens to almost all men as they age. It is not cancer.

An enlarged prostate is usually harmless, but it often causes problems with urination. About half of all men older than 75 have some symptoms.

The most important thing in deciding whether to get treatment is how much the symptoms bother you and how much they affect your quality of life.

Medicines are sometimes used to help relieve bothersome, moderate to severe urination problems caused by an enlarged prostate. If you stop using medicine, the symptoms will probably return.

Medicine choices include:

• Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue.
• 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate.
• A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.^{footnote 3}
• Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil (Cialis), may help reduce BPH symptoms whether or not you have erection problems. PDE-5 inhibitors are well known medicines for erection problems.^{footnote 4}
• Anticholinergic and antispasmodic medicines such as oxybutynin (for example, Ditropan) and tolterodine (Detrol) calm the nerves that control bladder muscles and increase bladder capacity. Taking an alpha-blocker medicine with an anticholinergic may help with symptoms better than either medicine alone.^{footnote 5, footnote 6}

If you don't want to take medicine, you can try watchful waiting while managing your symptoms at home.

Watchful waiting means you have regular checkups to be sure that your symptoms aren't getting worse. And you try making these small changes to your lifestyle to control your symptoms:

• Don't try to rush your urination. Try to relax while using the bathroom.
• Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
• Don't limit your fluid intake to avoid having to urinate. Drink fluids throughout the day. Limit fluids in the evening if you often wake up at night to urinate.
• Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
• If you can, avoid medicines that make your symptoms worse, such as nonprescription antihistamines, decongestants (including nasal sprays), and allergy pills. Talk to your doctor first.

Some men try dietary supplements for BPH, such as saw palmetto or beta-sitosterol. But scientific studies don't show that saw palmetto helps with urinary problems or that beta-sitosterol is safe or helps over the long term.

About 4 out of 10 men find that their symptoms improve without treatment. This means that 6 out of 10 men need medicine or surgery to help their symptoms.^{footnote 1}

Your doctor may recommend taking medicine for BPH if:

• You have tried to manage your symptoms through watchful waiting, but they still bother you.
• You have a large prostate, and your doctor feels that you may be at risk for urinary retention. (Urinary retention means you can't urinate because your prostate blocks your bladder from emptying.)