Medicines for benign prostatic hyperplasia

**5-alpha reductase inhibitors**
Reasons to use medicine	Reasons not to use medicine
You have a large prostate. Finasteride can reduce prostate size by 20%.^1,² Finasteride is effective in about 5 to 7 out of 10 men treated.³ Finasteride can reduce AUA symptom scores by 25% to 30%.³ Finasteride may reduce the risk of acute urinary retention (AUR) and AUR requiring catheterization. Finasteride may reduce the risk of future surgery for BPH.⁴ Finasteride may reduce the risk of recurrent blood in the urine if BPH is the cause.¹	Symptom relief may take up to 6 months. Side effects include decreased sex drive, reduced ejaculatory volume, and difficulty getting an erection. Some evidence suggests that it is less effective for symptom relief than alpha-blockers. It may be expensive over a lifetime.

Note: Data above only apply to finasteride.

**Alpha-blockers**
Reasons to use medicine	Reasons not to use medicine
Alpha-blockers are effective in 6 to 9 out of 10 men treated. How well they work depends on which alpha-blocker is used and how much of it is used.³ They can reduce AUA symptom scores by 15% to 44%.³ They relieve symptoms within 2 to 3 weeks. Some evidence suggests that they are more effective for symptom relief than finasteride.⁴ They can help relieve high blood pressure (potentially eliminating the need to take two medicines).	They do not affect prostate size. Side effects include weakness or fatigue; lightheadedness, dizziness, or fainting when standing; a slight decrease in blood pressure; and headaches and nasal congestion. When used alone, they do not reduce the risk of BPH complications that may require surgery. Men with liver or kidney disease need to be more careful about taking an alpha-blocker. If you are taking one of these medicines, you may need to have tests to check your liver or kidneys.

Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.^5,⁶

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Should I have surgery or take medication for benign prostatic hyperplasia?

References

Citations

Barry MJ (2007). Benign prostatic hyperplasia. In DC Dale, DD Federman, eds., ACP Medicine, section 10, chap. 13. New York: WebMD.

Kirby R, Lepor H (2007). Evaluation and nonsurgical management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2766–2802. Philadelphia: Saunders Elsevier.

Paterson R, Goldenberg L (2001). Benign prostatic hyperplasia. In J Teichman, ed., 20 Common Problems in Urology, part 2, pp. 185–198. New York: McGraw-Hill.

Webber R (2006). Benign prostatic hyperplasia, search date May 2005. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

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.

Roehrborn CG, et al. (2008). The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. Journal of Urology, 179(2): 616–621.

Credits

Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology
Last Updated	March 24, 2008