Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
If your benign prostatic hyperplasia (BPH) is causing lower urinary tract symptoms, options include watchful waiting, medication, and surgery. Generally, watchful waiting or medications are considered first, and then surgery. This Decision Point focuses on deciding between watchful waiting and medications.
Consider the following when making your decision:
- If you have acute urinary retention (AUR—a blockage of the urethra that makes urination impossible) that comes back, urinary tract infections that happen again, kidney problems, bladder stones or bladder infections, or blood in your urine, watchful waiting or medication is usually not an option. Talk to your doctor about surgery.
- The American Urological Association (AUA) symptom index is used to help men determine the severity of their urinary symptoms and can also be used to measure the effectiveness of treatment. However, the most important factor in deciding whether to get treatment is not your AUA rating, but how much the symptoms bother you and affect your quality of life.
- Your BPH symptoms may come and go, stabilize, or get better over time; there is a 31% to 55% chance that they will improve without treatment.1
- You may find the side effects of medication more bothersome than your BPH symptoms.
- Medications may decrease the risk for acute urinary retention and a future surgery for BPH.2, 3
Medical Information
What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that occurs in almost all men as they age. The enlargement is usually harmless, but it often results in problems urinating. About half of all men older than 50 experience some symptoms.
What are the risks of BPH?
BPH can be inconvenient and may affect your quality of life, but it is usually not a serious problem.
In a small number of cases, BPH may cause bladder outlet obstruction (BOO), making it impossible or extremely difficult to urinate. This may result in backed-up urine (urinary retention), leading to bladder infections or stones or kidney damage.
BPH may also irritate the bladder muscles as they enlarge to compensate for the increased force needed to empty the bladder.
BPH does not cause prostate cancer and does not affect a man's ability to father children; nor does it usually result in erection problems. But there is some association between severe symptoms of BPH and an increased risk of erection problems.
If you need more information, see the topic Benign Prostatic Hyperplasia (BPH).
Your Information
Your choices are:
- Try watchful waiting. Manage your BPH through fluid intake and bathroom techniques, and see your doctor regularly to monitor your condition.
- Use herbal therapy to relieve your symptoms.
- Use prescription medication to relieve your symptoms. Options include:
- Alpha-blockers, such as terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and prazosin (Minipress), which relax muscle tissue.
- 5-alpha reductase inhibitors, such as finasteride (Proscar) or dutasteride (Avodart), which shrink the prostate.
The decision about whether to use medications for BPH takes into account your personal feelings and the medical facts.
The American Urological Association (AUA) symptom index is used to help men determine the severity of their urinary symptoms and can also be used to measure the effectiveness of treatment. However, the most important factor in deciding whether to get treatment is not your AUA rating, but how much the symptoms bother you and affect your quality of life. Click here to determine the severity.
| Reasons to use medication | Reasons not to use a medication but to practice watchful waiting |
|---|---|
Are there other reasons you might want to use medications? |
Are there other reasons you might not want to use medications? |
| Reasons to use 5-alpha reductase inhibitors | Reasons not to use 5-alpha reductase inhibitors |
|---|---|
Are there other reasons you might want to use 5-alpha reductase inhibitors? |
Are there other reasons you might not want to use 5-alpha reductase inhibitors? |
| Reasons to use alpha-blockers | Reasons not to use alpha-blockers |
|---|---|
Are there other reasons you might want to use alpha-blockers? |
Are there other reasons you might not want to use alpha-blockers? |
A U.S. National Institutes of Health (NIH) study found that combining finasteride with the alpha-blocker doxazosin (Cardura) reduces the chances of symptoms getting worse, urinary retention, and the need to have surgery. The combination of the two medicines worked better than either medicine alone or when compared with a placebo.6
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using medication for benign prostatic hyperplasia. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| I have mild or moderate symptoms that don't really bother me. | Yes | No | Unsure |
| I have moderate or severe symptoms that bother me. | Yes | No | Unsure |
| I understand that my symptoms may come and go or get better or worse. | Yes | No | Unsure |
| I have a large prostate. | Yes | No | Unsure |
| I worry about the side effects of medication. | Yes | No | Unsure |
| I have tried watchful waiting and/or herbal therapies, and they didn't help. | Yes | No | NA* |
|
I have recurrent urinary retention, recurrent urinary tract infections, kidney problems, bladder stones or infection, or urine in the blood. |
Yes | No | NA |
*NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medications for benign prostatic hyperplasia.
Check the box below that represents your overall impression about your decision.
|
Leaning toward watchful waiting |
Leaning toward medications |
Return to the topic Benign Prostatic Hyperplasia (BPH).
References
Citations
Agency for Healthcare Research and Quality (1994). Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guidelines No. 8 (AHCPR Publication No. 94-0582). Rockville, MD: Agency for Healthcare Policy Research.
Webber R (2005). Benign prostatic hyperplasia. Clinical Evidence (14): 1076–1091.
McConnell JD, et al. (1998). The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. New England Journal of Medicine, 338(9): 557–563.
Barry MJ (2004). Benign prostatic hyperplasia. In DC Dale, DD Federman, eds., ACP Medicine, section 10, chap. 13. New York: WebMD.
Lepor HL, Lowe FC (2002). Evaluation and nonsurgical management of benign prostatic hyperplasia. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1297–1336. Philadelphia: W.B. Saunders.
McConnell JD, et al. (2003). The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. New England Journal of Medicine, 349(25): 2387–2398.
Credits
| Author | Monica Rhodes |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Christopher G. Wood, MD, FACS - Urology/Oncology |
| Last Updated | March 31, 2006 |
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