An enlarged prostate is benign and usually results from abnormal cell growth. Pharmaceutical treatments include alpha-blockers, inhibitors, and combination medications.

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The prostate is a gland that produces fluid that carries sperm during ejaculation. The prostate sits around the urethra, the tube that carries urine out of the body.

An enlarged prostate is also known as benign prostatic hyperplasia (BPH) — a noncancerous abnormal cell growth. Although the symptoms of BPH sometimes present similarly to those of prostate cancer, doctors do not link the two, and BPH does not increase a person’s chance of cancer.

A doctor will help a person choose the appropriate treatment for BPH based on the severity of their symptoms and their overall health.

In this article, we look at why a person may need medication for BPH, as well as the available types of medication and some alternative treatment options.

Alpha blockers are drugs that help relax the muscles close to the prostate. This relieves pressure and allows urine to flow more easily.

Examples of alpha blockers include:

These types of alpha-blockers are called selective alpha-1 blockers. They treat BPH by causing the prostate’s smooth muscle to relax, allowing urine to flow freely through the urethra.

Potential side effects

Potential side effects of alpha blockers include:

To help avoid these adverse effects, doctors recommend that people take the medication at night.

5-alpha reductase inhibitors block the production of the male sex hormone dihydrotestosterone, which accumulates in the prostate and may cause the prostate to grow.

Finasteride and dutasteride are examples of 5-alpha reductase inhibitors.

These medications prevent the progression of prostate growth or, in some cases, actively shrink the prostate. Doctors generally prescribe 5-alpha reductase inhibitors for moderately enlarged prostates because they work more slowly than alpha blockers.

Potential side effects

Side effects of 5-alpha reductase inhibitors may include:

Doctors typically prescribe phosphodiesterase-5 (PDE5) inhibitors to treat erectile dysfunction. These medications work by relaxing the smooth muscles in the lower urinary tract, which helps relieve symptoms of BPH.

Some examples of PDE5 inhibitors are:

For penile erection, nerve impulses cause the production of nitric oxide, which diffuses into the smooth muscle cells and stimulates the formation of messenger molecules called cyclic guanosine monophosphate (cGMP). This elicits cellular activity.

PDE5 inhibitors inhibit an enzyme called PDE5, which prevents the breakdown of cGMP. This allows the smooth muscle in the prostate to relax, promoting the dilation of penile arteries and the increase in blood flow necessary for a sustained erection.

Potential side effects

Side effects of PDE5 medications may include:

Doctors may also prescribe antimuscarinic drugs for BPH. Examples include:

  • mirabegron
  • oxybutynin
  • solifenacin
  • tolterodine
  • darifenacin
  • trospium
  • fesoterodine

Potential side effects

Several side effects are associated with these drugs, including:

However, the most serious side effect of antimuscarinic drugs is acute urinary retention (AUR).

According to some research, people who received antimuscarinic treatment for 1 month had a higher incidence of AUR than those who received long-term treatment.

Research has also found that anticholinergic and antispasmodic medications may worsen BPH symptoms. The researchers associate anticholinergic drugs with a higher risk of urinary retention in people with BPH.

Doctors typically prescribe desmopressin to treat symptoms of a type of diabetes insipidus, which causes the body to overproduce urine.

The medication can help with nocturia, the frequent need to urinate during the night. Research associates nocturia with lower urinary tract symptoms in people with BPH. In BPH treatment, doctors may combine the medication with other treatments, such as alpha blockers.

Potential side effects of desmopressin may include abnormal thinking and diarrhea.

This medication may also cause potentially serious side effects such as:

Combining two types of medication can be more effective for treating symptoms than one medication alone.

The following medication combinations can be effective:

  • alpha blockers and antimuscarinics, which help manage overactive bladder
  • dutasteride (a 5-alpha reductase inhibitor) and tamsulosin (an alpha blocker)
  • finasteride (a 5-alpha reductase inhibitor) and doxazosin (an alpha blocker)

A person may not need treatment for a mildly enlarged prostate that is not causing significant symptoms. In such cases, a person may need to visit a urologist for regular checkups and may need treatment only if the symptoms become problematic.

If the symptoms of BPH begin to bother a person, a doctor may prescribe medication to shrink the prostate or stop its growth. This may reduce associated symptoms such as:

Other treatments for BPH may include:

  • minimally invasive procedures
  • surgery
  • lifestyle changes

Minimally invasive procedures

Several minimally invasive procedures can widen the urethra to relieve blockages and tension or destroy enlarged prostate tissue. To perform these procedures, a doctor will insert a catheter or cytoscope through the urethra to reach the prostate.

Types of procedures include:

  • high intensity focused ultrasound
  • transurethral needle ablation
  • prostatic stent insertion
  • transurethral electrovaporization
  • transurethral microwave thermotherapy
  • water-induced thermotherapy

Surgery

A doctor may treat BPH with surgery. The surgery involves removing enlarged prostate tissue or making cuts in the prostate to widen the urethra.

Doctors may use the following types of surgery to remove enlarged prostate tissue:

  • laser surgery
  • transurethral resection of the prostate
  • transurethral incision of the prostate
  • open prostatectomy

Read more about BPH surgery.

Lifestyle changes

A doctor may recommend that a person with BPH make some lifestyle adjustments to help them manage the condition. These may include:

A doctor will help a person with BPH decide on the most appropriate treatment for the condition, depending on the severity of their condition, their overall health, and preferences.

A person may require other treatments in addition to medication. Treatment may involve a minimally invasive procedure that a doctor performs through a catheter, surgery to remove tissue from the prostate, or lifestyle adjustments.