Medications are sometimes used to help relieve bothersome, moderate to severe urination problems caused by benign prostatic hyperplasia (BPH). If you stop using medication, the symptoms will usually return.

The American Urological Association (AUA) symptom index is an interactive questionnaire that can help you determine how bad your urinary symptoms are and measure how well your treatment is working. But the most important factor in deciding whether to use medications is not your AUA score but how much the symptoms bother you and affect your quality of life. A high score on the AUA does not necessarily mean you need medications.

The side effects of the most commonly used medications are generally minor, and they stop when you stop taking the medication.

Should I use medication or watchful waiting to treat benign prostatic hyperplasia?

Medication Choices

• Alpha-blockers, including terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), prazosin (Minipress), and alfuzosin (Uroxatral), relieve symptoms within a few weeks but do not stop the process of prostate enlargement.
• 5-alpha reductase inhibitors, such as finasteride (Proscar) or dutasteride (Avodart), may reduce the size of an enlarged prostate but may take 6 months or more to show any effect on symptoms. These medicines may also decrease the amount of prostate-specific antigen (PSA) released into the blood by your prostate gland.

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.⁵

What To Think About

Alpha-blockers and 5-alpha reductase inhibitors affect different prostate tissues. The degree of improvement in your symptoms may depend on which tissue is contributing most to your symptoms. None of these medications will work for everyone.

Alpha-blockers may help symptoms caused by a blockage at the opening to the bladder. With this type of obstruction, you may have difficulty starting urination and have a weak urine stream. Alpha-blockers relax the smooth muscle tissue in the prostate and the opening to the bladder. This muscle tissue must relax to allow urine to flow.

5-alpha reductase inhibitors can reduce the size of your prostate and can slow the rate of enlargement. Men with smaller prostates see less benefit than those with larger prostates. Men who have only slightly enlarged prostates usually find alpha-blockers more helpful. 5-alpha reductase inhibitors may also decrease the amount of prostate-specific antigen (PSA) released into the blood by your prostate gland. But they may also cause you to have less desire to have sex (decreased libido).