Enlarged Prostate: Should I Take Medicine?

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You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Non-Interactive Decision Point

Enlarged Prostate: Should I Take Medicine?

Get the facts

Your options

  • Take prescription medicine to help your urinary symptoms.
  • Don't take medicine. Instead, try watchful waiting and manage your symptoms at home.

Urinary symptoms include needing to urinate often, having a weak urine stream, or having trouble starting a urine stream.

Watchful waiting and medicines are usually the first things considered for an enlarged prostate. Sometimes surgery is needed for more serious symptoms.

Key points to remember

  • Typically, you don't need medicine for an enlarged prostate unless the symptoms bother you or you have other problems such as bladder infections or bladder stones.
  • About 4 out of 10 men find that their symptoms improve without treatment. That means that 6 out of 10 men need medicine or surgery to help their symptoms.footnote 1
  • The side effects of medicine may bother you more than your symptoms.
  • Taking medicine may help keep you from needing surgery in the future.footnote 2
FAQs

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, or BPH, is better known as an enlarged prostate. It happens to almost all men as they age. It is not cancer.

An enlarged prostate is usually harmless, but it often causes problems with urination. About half of all men older than 75 have some symptoms.

The most important thing in deciding whether to get treatment is how much the symptoms bother you and how much they affect your quality of life.

What medicines are used to treat an enlarged prostate?

Medicines are sometimes used to help relieve bothersome, moderate to severe urination problems caused by an enlarged prostate. If you stop using medicine, the symptoms will probably return.

Medicine choices include:

  • Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue.
  • 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate.
  • A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.footnote 3
  • Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil (Cialis), may help reduce BPH symptoms whether or not you have erection problems. PDE-5 inhibitors are well known medicines for erection problems.footnote 4
  • Anticholinergic and antispasmodic medicines such as oxybutynin (for example, Ditropan) and tolterodine (Detrol) calm the nerves that control bladder muscles and increase bladder capacity. Taking an alpha-blocker medicine with an anticholinergic may help with symptoms better than either medicine alone.footnote 5, footnote 6
Comparing medicines

5-alpha reductase inhibitor

Alpha-blocker

  • For some men, it can shrink the prostate.
  • It may not work as well for symptom relief as alpha-blockers.footnote 2
  • Most men have improvement in symptoms with the medicine.footnote 7
  • Symptoms get better in about 6 months.
  • It may lower your risk of needing catheterization or surgery for blocked urine flow.footnote 2
  • Side effects include:
    • Reduced sex drive.
    • Less semen when you ejaculate.
    • Trouble getting an erection.
  • It doesn't affect prostate size.
  • It may work better than 5-alpha reductase inhibitors for symptom relief.footnote 2
  • Most men have improvement in symptoms with the medicine.footnote 7
  • Symptoms get better in 2 to 3 weeks.
  • For some people, it also helps lower high blood pressure a little.
  • Side effects include:
    • Weakness or fatigue.
    • Lightheadedness, dizziness, or fainting when you stand up.
    • A slight decrease in blood pressure.
    • Headaches and a stuffy nose.

What can you do if you don't want to take medicine?

If you don't want to take medicine, you can try watchful waiting while managing your symptoms at home.

Watchful waiting means you have regular checkups to be sure that your symptoms aren't getting worse. And you try making these small changes to your lifestyle to control your symptoms:

  • Don't try to rush your urination. Try to relax while using the bathroom.
  • Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
  • Don't limit your fluid intake to avoid having to urinate. Drink fluids throughout the day. Limit fluids in the evening if you often wake up at night to urinate.
  • Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
  • If you can, avoid medicines that make your symptoms worse, such as nonprescription antihistamines, decongestants (including nasal sprays), and allergy pills. Talk to your doctor first.

Some men try dietary supplements for BPH, such as saw palmetto or beta-sitosterol. But scientific studies don't show that saw palmetto helps with urinary problems or that beta-sitosterol is safe or helps over the long term.

About 4 out of 10 men find that their symptoms improve without treatment. This means that 6 out of 10 men need medicine or surgery to help their symptoms.footnote 1

Why might your doctor recommend medicine for BPH?

Your doctor may recommend taking medicine for BPH if:

  • You have tried to manage your symptoms through watchful waiting, but they still bother you.
  • You have a large prostate, and your doctor feels that you may be at risk for urinary retention. (Urinary retention means you can't urinate because your prostate blocks your bladder from emptying.)

Compare your options

Compare

What is usually involved?

















What are the benefits?

















What are the risks and side effects?

















Take medicine Take medicine
  • You take medicine every day for life.
  • You have regular checkups.
  • You may need to use special bathroom techniques, such as learning to relax and double voiding.
  • Taking medicine works for most men.footnote 8
  • You may lower your risk of urinary retention and future surgery.
  • Side effects of 5-alpha reductase inhibitors include reduced sex drive and trouble getting an erection.
  • Side effects of alpha-blockers include tiredness, dizziness, headaches, and a stuffy nose.
  • Some medicines are available in generic forms that may cost less, but medicines can be very expensive.
Don't take medicine Don't take medicine
  • You have regular checkups.
  • You use special bathroom techniques.
  • You make sure you don't cut back on fluids.
  • About 4 out of 10 men find that their symptoms improve without treatment.footnote 1
  • You avoid the side effects of the medicines.
  • You may keep having symptoms that bother you. About 6 out of 10 men need medicine or surgery to help their symptoms.footnote 1
  • If your prostate is large, you may be at risk for urinary retention.

Personal stories about using medicine for benign prostatic hyperplasia

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've been having a lot of trouble getting a good night's sleep now that I have this enlarged prostate. I'm up 4 or 5 times a night to go to the bathroom, and then both my wife and I are tired all day. My doctor said these medicines often help with that problem, so I'm going to try them. Even if I still had to get up a couple of times a night, I would get more rest and have more energy during the day.

Jake, age 61

When I started having problems urinating, my first thought was that it had to be cancer. My brother-in-law had similar symptoms, but he ignored them for a long time and eventually was diagnosed with prostate cancer. I decided not to ignore them, so I went right to my doctor. He did a rectal exam and a PSA test and said that he was confident that my prostate was just enlarged and that it did not appear that I had cancer. He said if I wanted something to treat the symptoms, he could prescribe medicine. But I was just happy that the problem wasn't from cancer, so I decided to manage the symptoms on my own for now.

Jim, age 65

I've been able to manage my BPH symptoms on my own for a couple years. They didn't bother me that much at first, and the tips my doctor gave me about limiting fluids and avoiding nonprescription decongestants really helped. But these days, my symptoms seem to be getting worse, and I'm tired of dealing with them. I know the medicine can have side effects, but I'm going to give it a try.

Michael, age 54

Several months ago, I started taking medicine to treat my prostate symptoms. The doctor said that most men don't have serious side effects, but I guess I'm one of the few who do. Feeling dizzy, lightheaded, and tired was affecting me more than my prostate symptoms were, so I decided to stop taking the medicine. I found that my symptoms actually got a little better by themselves. For now, I'm managing okay with home treatment. My doctor and I will keep talking about other options if my symptoms get worse and I decide I want to try something different.

Carl, age 58

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicine

Reasons not to take medicine

I have symptoms that really bother me.

My symptoms don't really bother me.

More important
Equally important
More important

I would rather live with side effects from medicine than have my symptoms.

I worry about the side effects of medicine.

More important
Equally important
More important

I don't mind taking medicine every day.

I don't want to take medicine every day.

More important
Equally important
More important

I'm not worried about how much the medicine will cost.

I really worry about how much the medicine will cost.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

NOT taking medicine

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, I may not need to take medicine if my symptoms don't bother me very much.
2, I may find that my symptoms improve without treatment.
3, Medicines can cause side effects that may be worse than my symptoms.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerJ. Curtis Nickel, MD, FRCSC - Urology
References
Citations
  1. Roehrborn CG (2012). Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2570-2610. Philadelphia: Saunders.
  2. McNicholas T, Kirby R (2011). Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1801/overview.html. Accessed April 12, 2016.
  3. 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.
  4. Liu L, et al. (2011). Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review and meta-analysis. Urology, 77(1): 123-130.
  5. MacDiarmid SA, et al. (2008). Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: Randomized, double-blind, placebo-controlled study. Mayo Clinic Proceedings, 83(9): 1002-1010.
  6. Kaplan SA, et al. (2006). Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA, 296(19): 2319-2328.
  7. AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
  8. Wilt TJ, N'Dow J (2008). Benign prostatic hyperplasia. Part 2-Management. BMJ, 336(7637): 206-210.
Other Works Consulted
  • McNicholas T, Kirby R (2011). Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1801/overview.html. Accessed April 12, 2016.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Enlarged Prostate: Should I Take Medicine?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Take prescription medicine to help your urinary symptoms.
  • Don't take medicine. Instead, try watchful waiting and manage your symptoms at home.

Urinary symptoms include needing to urinate often, having a weak urine stream, or having trouble starting a urine stream.

Watchful waiting and medicines are usually the first things considered for an enlarged prostate. Sometimes surgery is needed for more serious symptoms.

Key points to remember

  • Typically, you don't need medicine for an enlarged prostate unless the symptoms bother you or you have other problems such as bladder infections or bladder stones.
  • About 4 out of 10 men find that their symptoms improve without treatment. That means that 6 out of 10 men need medicine or surgery to help their symptoms.1
  • The side effects of medicine may bother you more than your symptoms.
  • Taking medicine may help keep you from needing surgery in the future.2
FAQs

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, or BPH, is better known as an enlarged prostate. It happens to almost all men as they age. It is not cancer.

An enlarged prostate is usually harmless, but it often causes problems with urination. About half of all men older than 75 have some symptoms.

The most important thing in deciding whether to get treatment is how much the symptoms bother you and how much they affect your quality of life.

What medicines are used to treat an enlarged prostate?

Medicines are sometimes used to help relieve bothersome, moderate to severe urination problems caused by an enlarged prostate. If you stop using medicine, the symptoms will probably return.

Medicine choices include:

  • Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue.
  • 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate.
  • A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.3
  • Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil (Cialis), may help reduce BPH symptoms whether or not you have erection problems. PDE-5 inhibitors are well known medicines for erection problems.4
  • Anticholinergic and antispasmodic medicines such as oxybutynin (for example, Ditropan) and tolterodine (Detrol) calm the nerves that control bladder muscles and increase bladder capacity. Taking an alpha-blocker medicine with an anticholinergic may help with symptoms better than either medicine alone.5, 6
Comparing medicines

5-alpha reductase inhibitor

Alpha-blocker

  • For some men, it can shrink the prostate.
  • It may not work as well for symptom relief as alpha-blockers.footnote 2
  • Most men have improvement in symptoms with the medicine.footnote 7
  • Symptoms get better in about 6 months.
  • It may lower your risk of needing catheterization or surgery for blocked urine flow.footnote 2
  • Side effects include:
    • Reduced sex drive.
    • Less semen when you ejaculate.
    • Trouble getting an erection.
  • It doesn't affect prostate size.
  • It may work better than 5-alpha reductase inhibitors for symptom relief.footnote 2
  • Most men have improvement in symptoms with the medicine.footnote 7
  • Symptoms get better in 2 to 3 weeks.
  • For some people, it also helps lower high blood pressure a little.
  • Side effects include:
    • Weakness or fatigue.
    • Lightheadedness, dizziness, or fainting when you stand up.
    • A slight decrease in blood pressure.
    • Headaches and a stuffy nose.

What can you do if you don't want to take medicine?

If you don't want to take medicine, you can try watchful waiting while managing your symptoms at home.

Watchful waiting means you have regular checkups to be sure that your symptoms aren't getting worse. And you try making these small changes to your lifestyle to control your symptoms:

  • Don't try to rush your urination. Try to relax while using the bathroom.
  • Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
  • Don't limit your fluid intake to avoid having to urinate. Drink fluids throughout the day. Limit fluids in the evening if you often wake up at night to urinate.
  • Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
  • If you can, avoid medicines that make your symptoms worse, such as nonprescription antihistamines, decongestants (including nasal sprays), and allergy pills. Talk to your doctor first.

Some men try dietary supplements for BPH, such as saw palmetto or beta-sitosterol. But scientific studies don't show that saw palmetto helps with urinary problems or that beta-sitosterol is safe or helps over the long term.

About 4 out of 10 men find that their symptoms improve without treatment. This means that 6 out of 10 men need medicine or surgery to help their symptoms.1

Why might your doctor recommend medicine for BPH?

Your doctor may recommend taking medicine for BPH if:

  • You have tried to manage your symptoms through watchful waiting, but they still bother you.
  • You have a large prostate, and your doctor feels that you may be at risk for urinary retention. (Urinary retention means you can't urinate because your prostate blocks your bladder from emptying.)

2. Compare your options

  Take medicine Don't take medicine
What is usually involved?
  • You take medicine every day for life.
  • You have regular checkups.
  • You may need to use special bathroom techniques, such as learning to relax and double voiding.
  • You have regular checkups.
  • You use special bathroom techniques.
  • You make sure you don't cut back on fluids.
What are the benefits?
  • Taking medicine works for most men.8
  • You may lower your risk of urinary retention and future surgery.
  • About 4 out of 10 men find that their symptoms improve without treatment.1
  • You avoid the side effects of the medicines.
What are the risks and side effects?
  • Side effects of 5-alpha reductase inhibitors include reduced sex drive and trouble getting an erection.
  • Side effects of alpha-blockers include tiredness, dizziness, headaches, and a stuffy nose.
  • Some medicines are available in generic forms that may cost less, but medicines can be very expensive.
  • You may keep having symptoms that bother you. About 6 out of 10 men need medicine or surgery to help their symptoms.1
  • If your prostate is large, you may be at risk for urinary retention.

Personal stories

Personal stories about using medicine for benign prostatic hyperplasia

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've been having a lot of trouble getting a good night's sleep now that I have this enlarged prostate. I'm up 4 or 5 times a night to go to the bathroom, and then both my wife and I are tired all day. My doctor said these medicines often help with that problem, so I'm going to try them. Even if I still had to get up a couple of times a night, I would get more rest and have more energy during the day."

— Jake, age 61

"When I started having problems urinating, my first thought was that it had to be cancer. My brother-in-law had similar symptoms, but he ignored them for a long time and eventually was diagnosed with prostate cancer. I decided not to ignore them, so I went right to my doctor. He did a rectal exam and a PSA test and said that he was confident that my prostate was just enlarged and that it did not appear that I had cancer. He said if I wanted something to treat the symptoms, he could prescribe medicine. But I was just happy that the problem wasn't from cancer, so I decided to manage the symptoms on my own for now."

— Jim, age 65

"I've been able to manage my BPH symptoms on my own for a couple years. They didn't bother me that much at first, and the tips my doctor gave me about limiting fluids and avoiding nonprescription decongestants really helped. But these days, my symptoms seem to be getting worse, and I'm tired of dealing with them. I know the medicine can have side effects, but I'm going to give it a try."

— Michael, age 54

"Several months ago, I started taking medicine to treat my prostate symptoms. The doctor said that most men don't have serious side effects, but I guess I'm one of the few who do. Feeling dizzy, lightheaded, and tired was affecting me more than my prostate symptoms were, so I decided to stop taking the medicine. I found that my symptoms actually got a little better by themselves. For now, I'm managing okay with home treatment. My doctor and I will keep talking about other options if my symptoms get worse and I decide I want to try something different."

— Carl, age 58

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicine

Reasons not to take medicine

I have symptoms that really bother me.

My symptoms don't really bother me.

       
More important
Equally important
More important

I would rather live with side effects from medicine than have my symptoms.

I worry about the side effects of medicine.

       
More important
Equally important
More important

I don't mind taking medicine every day.

I don't want to take medicine every day.

       
More important
Equally important
More important

I'm not worried about how much the medicine will cost.

I really worry about how much the medicine will cost.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

NOT taking medicine

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. I may not need to take medicine if my symptoms don't bother me very much.

  • True
  • False
  • I'm not sure
You're right. Typically, you don't need medicine unless your symptoms bother you or you have other problems such as bladder infections or bladder stones.

2. I may find that my symptoms improve without treatment.

  • True
  • False
  • I'm not sure
You're right. About 4 out of 10 men find that their symptoms improve without treatment.

3. Medicines can cause side effects that may be worse than my symptoms.

  • True
  • False
  • I'm not sure
Correct. The side effects of medicine may bother you more than your symptoms.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerJ. Curtis Nickel, MD, FRCSC - Urology
References
Citations
  1. Roehrborn CG (2012). Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2570-2610. Philadelphia: Saunders.
  2. McNicholas T, Kirby R (2011). Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1801/overview.html. Accessed April 12, 2016.
  3. 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.
  4. Liu L, et al. (2011). Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review and meta-analysis. Urology, 77(1): 123-130.
  5. MacDiarmid SA, et al. (2008). Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: Randomized, double-blind, placebo-controlled study. Mayo Clinic Proceedings, 83(9): 1002-1010.
  6. Kaplan SA, et al. (2006). Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA, 296(19): 2319-2328.
  7. AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
  8. Wilt TJ, N'Dow J (2008). Benign prostatic hyperplasia. Part 2-Management. BMJ, 336(7637): 206-210.
Other Works Consulted
  • McNicholas T, Kirby R (2011). Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1801/overview.html. Accessed April 12, 2016.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: March 14, 2017

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & J. Curtis Nickel, MD, FRCSC - Urology