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Flomax is an alpha-blocker, both 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:
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 in 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.
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.
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 prostates larger 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 ejaculation 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. Rich 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, and Dr. Rich Bevan-Thomas uses this often for men who take one of the 5-ARI drugs.
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.
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 sees a response). Dr. Rich Bevan-Thomas agrees with the literature that Cialis tends to work best in younger men who also see the improvement in erections as well.