Medical Treatment for Benign Prostatic Hyperplasia (BPH), Enlarged Prostate
There are several treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms. If symptoms do not threaten the man's health, he may choose not to be treated. If symptoms are severe enough to cause discomfort, interfere with daily activities, or threaten health, treatment is usually recommended.
Watchful Waiting and Mild BPH
Men with mild symptoms may choose to return for annual examinations. The physician will perform an examination that includes a DRE, PSA tests, and a urinary flow rate. The patient will be asked to describe symptoms in order to determine if the condition is worsening.
Medication to Treat BPH
5-Alpha reductase inhibitors such as finasteride (Proscar) and dutasteride (Avodart) prevent the conversion of testosterone to the hormone dihydrotestosterone (DHT). In many cases, a treatment period of 6-month is necessary to see if the therapy is going to work. These drugs are taken orally, once a day. Finasteride is available in tablet form and dutasteride is available as soft gelatin capsules. Patients should see their physician regularly to monitor side effects and adjust the dosage, if necessary.
Side effects include reduced libido, impotence (erectile dysfunction, ED), breast tenderness and enlargement, and reduced sperm count. Long-term risks and benefits have not been studied.
Women who may be pregnant must avoid handling dutasteride capsules and broken or crushed finasteride tablets because exposure to the drugs may cause serious side effects to the fetus. Intact tablets are coated to prevent absorption through the skin during normal handling. Patients should wait at least 6 months after dutasteride treatment to donate blood to prevent pregnant women from being exposed to the drug through blood transfusion.
Alpha blockers relax smooth muscle tissue in the bladder neck and prostate, which increases urinary flow. They typically are taken orally, once or twice a day.
Commonly prescribed alpha blockers include the following:
- alfuzosin (UroXatral), extended-release tablet taken once daily
- doxazosin (Cardura), tablet taken once daily
- prazosin (Minipress), capsule taken 2 or 3 times daily
- silodosin (Rapaflo), capsule taken once daily
- tamsulosin hydrochloride (Flowmax), capsule taken once daily
- terazosin (Hytrin), capsule taken once daily
Patients taking an alpha blocker require follow-up during the first 3 or 4 weeks to evaluate the effect on symptoms and adjust the dosage, if necessary. Side effects include headache, diarrhea, dizziness, low blood pressure, fatigue, weakness, and difficulty breathing. Long-term risks and benefits have not been studied.
In October 2011, the FDA approved tadalafil (Cialis) to treat BPH symptoms. This drug also is used to treat erectile dysfunction (ED). Cialis should not be used by men who are taking nitrates (e.g., nitroglycerin) or in those who are also taking alpha blockers for BPH, because the combination of these drugs can cause a dangerously low blood pressure.
Prostatic Stents to Treat BPH
Although a prostatic stent is not a medical treatment, neither does it fall under the classification of a surgical procedure. Prostatic stents are used most often for patients with significant medical problems that prohibit medication or surgery. It is a tiny, springlike device inserted into the urethra. When expanded, it pushes back the surrounding tissue and widens the urethra. Prostatic stents have several advantages:
- They can be placed in less than 15 minutes under regional anesthesia.
- Bleeding during and after surgery is minimal.
- The patient can be discharged the same day or the next morning.
There are also several disadvantages:
- Prepositioning can be difficult.
- They may cause irritation and frequent urination.
- They may cause pain or urinary incontinence.
- Removing them (necessary in one-third of cases) can be difficult.
In some cases, a temporary prostatic stent, such as the Spanner Temporary Prostatic Stent, may be used following minimally invasive BPH treatment. This single-use, disposable device is designed to reduce obstruction and improve urination for as many as 30 days after removal of the urinary catheter.
Temporary stents are inserted into the urethra and held in place by a small balloon in the bladder and a soft anchor. Adverse effects include urinary tract infection (UTI), painful or frequent urination, movement of the stent, and formation of a blood clot. Blood clots and device movement may result in urinary retention (inability to urinate), which is a medical emergency.