BPH: We’ve Got a Pill for That...

prostate anatomy

...but there’s a catch. Keep reading to find out what it is.

You’re a man and waking up at night. Your stream is slowing down, and you’re becoming more aware of the locations of the restrooms every time you leave the house. You likely have a growing prostate, also referred to as BPH or an enlarged prostate.

If this is your first article at Dr. Bevan-Thomas.com, start by filling out your IPSS questionnaire so we can figure out how serious your symptoms are This is an important step, as we will touch upon later in this article.

Done? Perfect. Now that you know your score, let’s talk about options. In this article, we’ll focus on medications.

BPH medications are broken down into two categories: alpha blockers (prostate muscle relaxers) and 5-alpha-reductase inhibitors (prostate shrinkers). Over the last few years, Cialis (an ED medication called a PDE5 inhibitor) was also noted to have some benefit for BPH.

There are over-the-counter medications available as well, but unfortunately, most of them have not proven to be very effective. But we’ll get to that in a future post.

WHAT ABOUT FLOMAX? I'VE HEARD OF THAT

Flomax is an alpha blocker. Alpha blockers simply relax the smooth muscle part of the prostate and open the urine channel, thus making it easier for the bladder to empty. Remember that urine travels through the prostate, and the tighter the channel, the more difficult it is for the urine to flow.

Most of these drugs are very similar (see list below), but with the release of Flomax in 1993, the race was on to produce a medication with fewer side effects. This continued until recently, when the latest BPH medication (Rapaflo) went generic. Fortunately, all of the current alpha blockers are generic.

Current alpha blockers include:

  • Terazosin (Hytrin)
  • Doxazosin (Cardura)
  • Tamsulosin (Flomax)
  • Alfuzosin (Uroxatral)
  • Silodosin (Rapaflo)

SO DO ALPHA BLOCKERS WORK?

Here’s the catch with alpha blockers: Roughly 50% of men may see a benefit from an alpha blocker, but unfortunately, the results are disappointing. This is where that IPSS questionnaire comes into play.

While there are ways of evaluating a man’s urinary flow and bladder emptying, the easiest way is to have them fill out the IPSS score before and after a medication trial.

The improvement on the IPSS score for men taking alpha blockers was roughly 6-7 points. So this improves urinary function slightly but not as effectively as some of the other options, such as procedures that open the prostate.

I HEARD MEN GET DIZZY WITH MEDICATION OR HAVE ED ISSUES

Just as importantly, these medications all have side effects, and they don’t prevent the growth of the prostate, thus leading to worsening symptoms later in life. Therefore, you need to take them every day to maintain their efficacy. There is also a high likelihood that men will need some type of intervention later to relieve the obstruction.

The most common side effects include asthenia (lack of energy), dizziness, headache, and nasal congestion. They can also cause ejaculation dysfunction with decreased ejaculation volume or retrograde ejaculation (meaning the semen travels back into the bladder instead of out through the penis).

Some men respond well to the medication without side effects, and that is truly encouraging. However, it is extremely important that these men be followed closely, as there is a high risk that the meds will stop working at some point.

OK, SO WHAT ABOUT THE PROSTATE-SHRINKING MEDICINE?

The other primary medication for BPH is the 5-alpha-reductase inhibitors, or prostate shrinkers. These drugs include finasteride and dutasteride, and they work by blocking the conversion of testosterone to dihydrotestosterone, thus shrinking the prostate. They can reduce prostate size by as much as 25% and lower the PSA by roughly 50%.

However, these drugs primarily shrink the outside of the prostate (not the inner part that slows the stream) and only work slightly for men with larger prostates greater than 40 grams.

The improvement for these men was even less than with the alpha blockers — only 4 points on the IPSS score. This is not really enough to make a large difference for men.

Side effects for the 5-ARI drugs primarily include decreased ejacuation volume along with erectile dysfunction and decreased libido. While some men benefit from these drugs, most urologists use them sparingly these days because of the very low potential risk of causing higher-grade prostate cancer. Dr. Bevan-Thomas always discusses this with his patients and follows them closely.

Fortunately, the prostate MRI has given urologists a much better way to evaluate the prostate (see MRI article), and Dr. Bevan-Thomas uses this often for men who take one of the 5-ARI drugs.

WHAT ABOUT CIALIS? COULD THAT BE THE ANSWERS TO MY PRAYERS?

Cialis is a PDE5 inhibitor, so it not only improves urinary function, it also improves a man’s ability to attain and maintain an erection.

SO THAT'S A WIN-WIN RIGHT?

Not always. Cilias has the fewest of all of the side effects for BPH, including heartburn, headache, and lower back pain, but a few studies show that it only improves the IPSS score by 4 points. In other words, it may be helpful but not as effective as the alpha blockers (assuming you are one of the patients who actually see a response). Dr. Bevan-Thomas agrees with the literature that Cialis tends to work best in younger men who also see the improvement in erections as well.

TO MED OR NOT TO MED; THAT IS THE QUESTION!

In summary, if you or a loved one has BPH or an enlarged prostate, the answer is, “Yes, we’ve got a drug for that.” But finding one that works for you may not be that easy. Many of these drugs are somewhat effective in about half of men, but they also have side effects, which are often overlooked.

If you have been taking these medications with a good response, then great; keep taking them. But Dr. Bevan-Thomas recommends you follow with your urologist closely, as there is a higher risk that the bladder or prostate could have further problems down the road.

If you have taken the meds and had side effects or are looking for other alternatives, please read about your BPH options. Dr. Bevan-Thomas treats all size prostates from the very small to the enormous.

At the end of the day, it’s your body and your decision. Dr. Bevan-Thomas and his team want to give you the options to get you back on track again — alert, alive, and with a better stream. ;-)

Urologist Dr. Richard Bevan-Thomas of Urology Partners
Home - DrBevan-Thomas.com
Locations & Contacts
© Dr. Richard Bevan-Thomas - All rights reserved.
Disclaimer, Privacy, Terms of Use & Accessibility Statement