Treatments for Enlarged Prostate

An enlarged prostate, known as benign prostatic hyperplasia (BPH), mainly affects men over 50. While the condition is not considered life-threatening, it can cause problems with urination. Medications are available to treat BPH, when needed, which can reduce inflammation and even reverse enlargement in many cases.

Knowing the Right Time to Start

While it may seem reasonable to treat on diagnosis, evidence largely suggests that may not be necessary. According to the National Institutes of Diabetes, Digestive, and Kidney Disorders (NIDDKD), as many as one in three men with BPH will see their symptoms resolve without any treatment whatsoever. As such, most specialists will encourage you to take a wait-and-see approach and not rush into treatment.

Treatment is typically started when the symptoms of prostate enlargement result in either urinary tract bleeding or serious or recurrent urinary infections. It may also be started when the frequency of urination and/or physical discomfort of prostate enlargement adversely impacts daily living.

There are several types of drugs with different mechanisms of action that can be used to treat or minimize symptoms of BPH.

Alpha Blockers

Alpha blockers work by relaxing the muscles of the prostate and bladder neck. While alpha blockers are effective in around 75% of cases, they typically provide only modest relief and, as such, are usually reserved for men with milder symptoms.

The U.S. Food and Drug Administration (FDA) has approved six alpha blockers for the U.S. market:

• Cardura (doxazosin)
• Flomax (tamsulosin)
• Hytrin (terazosin)
• Rapaflo (silodosin)
• Minipress (prazosin)
• Uroxatral (alfuzosin)

If you are prescribed an alpha blocker, expect to be monitored during the first few weeks to check for side effects and signs of improvement. The majority of men with mild BPH will start to feel the positive effects within one to two days.

Common side effects may include headache, dizziness, upset stomach, tiredness, sinus congestion, and low blood pressure. Erectile dysfunction and impotence can also occur.

5-Alpha Reductase Enzyme Inhibitors

5-alpha reductase enzyme inhibitors work by shrinking the prostate gland and are most effective in men whose prostate is significantly enlarged. While it may take time for the drugs to take full effect (from three to six months on average), they can often help men avoid the need for surgery.

Two different 5-alpha reductase inhibitors have been approved by the FDA:

• Proscar or Propecia (finasteride)
• Avodart (dutasteride)

Side effects may include a low libido, impotence, and reduced semen production. (Finasteride at a lower dose is also popularly used to treat male pattern baldness.)

Combination Drug Therapy

The best candidates for combination therapy are men with enlarged prostate and high PSA levels. An alpha blocker combined with a 5-alpha-reductase inhibitor provides benefit by relaxing the prostate gland while gradually reducing its size.

A large-scale study conducted in 2006 showed that combination therapy resulted in a 66% reduction in symptoms of BPH compared to 34% with an alpha-blocker and 39% with a 5-alpha-reductase inhibitor alone.

The only downside may be that combination therapy exposes the user to side effects for both drugs. Careful consultation with a qualified specialist is recommended to weigh the benefits and consequences of treatment.

Phosphodiesterase-5 Inhibitors

Tadalafil (Cialis) is a phosphodiesterase-5 inhibitor approved by the FDA for BPH treatment. Though it has been shown to improve urinary tract symptoms in studies, its effects on urine flow are inconsistent, and it is not more effective than alpha blockers, according to a 2018 Cochrane review.

Surgical Options

If you’ve tried a combination of medications for 12 to 24 months but are still experiencing significant symptoms, you may be a candidate for surgical treatment for BPH.

Transurethral Resection of the Prostate (TURP)

In a transurethral resection of the prostate (TURP), tiny sections of the enlarged prostate are removed one at a time until all the excess tissue is excised. The procedure takes about an hour to 90 minutes and is performed under general, spinal, or epidural anesthesia, or with a nerve block.

Most men who undergo this procedure experience a significant decrease in urinary symptoms. However, complications occur in about 20 percent of men undergoing the procedure. You’ll generally be kept in the hospital for 24 hours after the procedure so your health care providers can monitor you for post-operative complications such as bleeding or electrolyte abnormalities.

In addition, since remaining prostate tissue continues to grow, 20 percent of patients find their symptoms eventually return within 10 years, at which point a second TURP may be recommended.

Prostatic Urethral Lift (Urolift)

The prostatic urethral lift (PUL, or Urolift) device compresses enlarged prostate tissue so that it is no longer in the way of the uretha, restoring urine flow. It is a minimally invasive endoscopic procedure done under local, general, or regional anesthesia. 

Heat Therapy (Hyperthermia)

Heat therapy (hyperthermia) is an outpatient treatment that is sometimes used to avoid surgery. The procedure involves the insertion of a thin, flexible device into the urethra to deliver heat directly to the prostate gland. It can employ either microwave, laser, or electro-vaporization technology and has been shown to be 74.9% effective in shrinking an enlarged gland.

As a more invasive procedure, hyperthermia should only be used in men in whom drug therapies have failed. Local anesthesia is used and recovery typically takes a few days.

Home-based heat therapy may be performed as an adjunct to medication. This can be done by applying a heating pad or hot-water bottle directly to the area to increase blood flow and alleviate pain and inflammation.

Alternative Therapies

The use of alternative therapies for prostate health has become extremely popular around the world. The most widely used plant extract is that of saw palmetto (Serenoa repens).

While a 1996 study from the U.S. Department of Veteran Affairs suggested that saw palmetto was as effective as finasteride in reducing the size of an enlarged prostate, a 2006 study published in the New England Journal of Medicine directly contradicted those findings.

Read how herbs can help with an enlarged prostate.