Medical therapy

When medicines are offered

Medicines are offered when symptoms are moderate or bother is high. They are also offered if watchful waiting has not helped enough.

The two main drug classes have different jobs. Alpha blockers ease the outlet. Five-alpha-reductase inhibitors shrink the gland.

Your clinician matches the class to your situation. Prostate size, bother level, and other health issues all guide the choice.

Alpha blockers

Alpha blockers relax muscle around the bladder outlet and prostate. Symptoms often ease within days to weeks.

Common names you will hear include tamsulosin and alfuzosin. They do not change prostate size.

Side effects can include dizziness, stuffy nose, and a drop in blood pressure on standing. A change in ejaculation is possible; some men notice less volume.

Five-alpha-reductase inhibitors

Five-alpha-reductase inhibitors, or 5-ARIs, shrink the prostate slowly. Benefit builds over three to six months.

Finasteride and dutasteride are the usual names. They lower PSA by about half, which your clinician will factor in.

Side effects can include reduced libido, a dip in erectile function, and occasional breast tenderness. Many effects ease after stopping, though not always.

Combination therapy

Men with larger prostates often do better on both classes together. Recent prescription data from a national cohort in South Korea show 5-ARI combinations are used more often with increasing age[¹].

A combination tackles two problems at once. The outlet relaxes while the gland slowly shrinks.

The trade-off is more side effects to track, and two prescriptions instead of one.

Other options

Anticholinergic or beta-3 agonist medicines may be added for storage symptoms. They are aimed at an overactive bladder picture, not at the outlet.

Phosphodiesterase-5 inhibitors, used for erectile function, also ease some BPH symptoms. Tadalafil is the usual choice here.

Herbal products are widely sold. Evidence is mixed, and quality varies between brands, so discuss before starting one.

Side effects to know

Sexual side effects are a common concern. Your clinician should raise them before you start, not after.

If sexual function changes, tell your clinician. Switching, pausing, or lowering a dose is often possible.

Stopping a 5-ARI changes PSA readings. Your follow-up plan should account for this.

Follow-up and review

Give an alpha blocker about four weeks to show effect. Give a 5-ARI six months, because the shrinkage takes time.

A review visit compares your IPSS before and after. The bother score often moves more than the total.

Keep medicines in a weekly box if you find that helps. Missed doses of either class reduce the benefit you can feel.