Benign Prostatic Hyperplasia
Treatment - Medications
Medical treatment for BPH is a relatively new development. There are 3 different classes of medications that are available to treat the lower urinary tract symptoms associated with BPH.
Phytotherapeutic Agents
Phytotherapeutic agents are over-the-counter medications that you find in your grocery, pharmacy, or a health food store. They have been very popular in Europe for many years, and recently, their popularity has increased in the United States as well. The most popular one of these phytotherapeutic agents is Saw Palmetto. There are other phytotherapeutic substances for BPH such as Pygeum Africanum, Rye pollen, pumpkin seeds, and others.
It has been suggested that these phytotherapeutic agents improve the symptoms in a majority of patients, however, there are not very many carefully conducted studies available that use control groups who are given either no treatment (placebo treatment) or an active comparator treatment. None of these agents have been shown to affect any characteristics of the prostate that can be measured directly such as the volume of the prostate, the serum PSA, or even the urinary flow rate. For the most part, they seem to affect symptoms only. place in the United States.
Some physicians believe that all of this is entirely due to a so-called placebo effect. The placebo effect refers to the phenomenon that many patients feel better and have improvement in their symptoms just by taking some medication, however, effective or ineffective it may be. It is certainly true that for the most part, phytotherapeutic agents are safe and very few serious adverse events have been reported. However, they are not produced under tightly controlled conditions monitored by the Food and Drug Administration, and many of them are imported from Asian countries. If you select one of these phytotherapeutic agents, you may want to pick a brand name that you are familiar with and where you know that the manufacturing process takes place in the United States.
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Alpha Adrenergic Receptor Blockers
Another class of medications are the so-called alpha adrenergic receptor blockers. These drugs have been originally developed to treat high blood pressure. Physicians have found out that they reduce the tension of the smooth muscle not only in blood vessels, but also in the prostate and the bladder outlet. These drugs are called doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax). Doxazosin and terazosin are meanwhile available as generics, while tamsulosin or Flomax is only available as a brand name. Tamsulosin is the only drug that does not require a so-called dose titration. Both doxazosin and terazosin have to be started up in a very low dose and this dose has to be increased over a period of 2 weeks or so in order to avoid certain kinds of adverse events.
All 3 drugs have just about the same efficacy in terms of improvement in your symptoms and your urinary flow rate. The drugs, however, have different adverse event profiles.
Dizziness, lightheadedness, fatigue, asthenia, and headaches are the most commonly reported side effects of these medications. Tamsulosin (Flomax) can induce a symptom called retrograde ejaculation which refers to the fact that the semen during ejaculation and climax goes back into your bladder rather than coming out forward. This is not dangerous, but could be somewhat of a nuisance.
The alpha blockers work almost immediately, i.e., you should see an improvement in your symptoms within a month or so. They do not affect the size of the prostate or the PSA and it is currently unclear whether or not they affect long term outcomes such as the risk of having to have surgery or experiencing acute urinary retention.
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Five Alpha-Reductase Inhibitors
Prostate growth is to some degree controlled by the male sex hormone testosterone and a metabolic byproduct called dihydrotestosterone or DHT. Finasteride (Proscar) inhibits an enzyme that is necessary to convert testosterone to dihydrotestosterone. This enzyme is called five alpha-reductase type II. By inhibiting this enzyme, the conversion of testosterone to dihydrotestosterone is blocked, and over a period of 3 to 6 months, this causes a shrinkage of your prostate by about 20 to 30%. Furthermore, it reduces your symptom PSA by an average of 50%. This is very important. If you have your PSA checked while on Proscar, the number needs to be multiplied by 2 to derive at the corrected and actual PSA value.
Proscar should only be given to men who have a PSA value of over 1.5 ng/ml and a prostate volume of over 30 ml by transrectal ultrasound or as estimated by DRE.
It works best in those patients, while in patients with very small glands and lower PSA values, it is less effective. It has recently been shown not only to improve the symptoms and the urinary flow, but also to reduce the chances of you experiencing outcomes such as acute urinary retention or having to have a surgery in the future. In fact, the risk for these problems to occur is reduced by approximately 50%.
Finasteride (Proscar) can interfere with sexual functioning. In about 1 out of 10 men a decreased volume of ejaculate is noted, a reduction in libido or sex drive, or even difficulties with achieving and maintaining an erection. Some patients experience breast enlargement. If you have this problem, you should talk to your doctor about discontinuing the medication.
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For more information about the Department of Urology, contact:
Phone: 214-648-4765, FAX: 214-648-4789
Mailing Address: 5323 Harry Hines Blvd., J8.148, Dallas, TX 75390-9110
