If a man with an enlarged prostate, also called benign prostatic hyperplasia (BPH), has symptoms that seem unmanageable with lifestyle measures alone, he should talk to his doctor about his options. When symptoms worsen, the first line of treatment is usually a prescription drug. The FDA has approved a total of eight drugs for BPH, which fall into three categories.
5-alpha reductase inhibitors. The drugs in the first category inhibit the enzyme 5-alpha-reductase, which in turn decreases the production of the hormone (dihydrotestosterone) that causes BPH. The two FDA-approved 5-alpha-reductase inhibitors are finasteride (Proscar) and dutasteride (Avodart). Potential side effects include reduced sexual function and desire, and possibly a slight increase in the risk for aggressive prostate cancer.
Alpha blockers. The second category of drugs are the alpha-blockers, whose action is to relax the smooth muscle in the prostate and in the neck of the bladder, thereby decreasing the blockage of urine flow. The five FDA-approved drugs in this group are terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral), tamsulosin (Flomax), and silodosin (Rapaflo). Their potential side effects include reduced sexual function, low blood pressure, and dizziness. Alpha-blockers can also cause serious adverse effects when taken with drugs for erectile dysfunction; ask your doctor about precautions you should take.
PDE-5 inhibitor. The one drug in the third and newest category is tadalafil, better known as Cialis, which is mostly used for treating erectile dysfunction. Tadalafil inhibits the enzyme phosphodiesterase-5 (PDE-5), but how that results in reduction of BPH symptoms is not yet known. Though tadalafil is FDA-approved for the treatment of BPH, we are not aware of any insurance plan that pays for it even in part, unlike the case for all the other BPH medications. But just like all the other BPH medicines, to be effective tadalafil must be taken daily, so out-of-pocket costs for it can be high. The most common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose; unusual side effects include a sudden decrease or loss of vision or hearing.
Combination medication. Finally, the FDA has approved one combination medication containing one drug from each of the first two categories, namely dutasteride and tamsulosin. It’s sold under the name Jalyn.