For men with prostate symptoms who are not badly affected, who do not want to consider surgery or are not fit enough for an operation, there is an alternative. BPH can now by treated with drugs. There are two sorts of drug – one makes the prostate smaller and the other relaxes the muscle in the prostate and bladder neck. Both types of drug can reduce the obstruction caused by the prostate sufficiently to relieve the symptoms.
The other type of drug used for treating BPH is called an alpha-blocker. Contraction of this muscle narrows the opening of the bladder and increases any obstruction caused by BPH. Alpha-blockers relax the muscle, reduce the obstruction and so improve symptoms. These drugs, unfortunately, affect muscle in other parts of the body, especially in blood vessels, and can cause side-effects such as faintness, weakness and lethargy.
This type of drug is also used to treat high blood pressure but some of the newer ones seem to act more on the prostate than other organs and may have fewer side-effects. Their big advantage is that they do work almost immediately. At present, alfuzosin (Xatral), doxazosin (Cardura), indoramin (Doralese), prazosin (Hypovase), tamsulosin (Flomax MR) and terazosin (Hytrin) are in use and other ones will be introduced soon. They differ in how often they need to be taken, and some of them need to be built up from a small dose. Their side-effects differ, so if one is not suitable, it is worth trying another. Alpha-blockers can cause retrograde ejaculation, but this will revert to normal if the drug is stopped. Just as with hormone treatment, the rate of urinary flow is only slightly improved.
Choice of Drug
Which of these two types of drug is prescribed depends on a number of things. Some men, often those whose symptoms occur at a youngish age, do not have much actual enlargement of the prostate. For them, the action of the prostatic muscle seems to be the main cause of the obstruction and so an alpha-blocker is the best choice.
If a man with a prostate like this does need an operation, the surgeon may not have to cut away any prostate but may just make an incision in one or two places to open it up. The patient himself will not really be able to tell much difference from an ordinary TURP. Finasteride probably should be prescribed only when the prostate is definitely enlarged, and it does seem that, the bigger the prostate, the more effective it will be. As it takes some time to shrink the prostate, the patient must be prepared for the effects to occur. Trials are being conducted to see if a combination of finasteride with one of the alpha-blocker drugs can reduce this delay.
Drug treatment is usually suggested if symptoms are mild, the obstruction is not too bad and there is no reason to avoid a particular drug. Drugs may be tried in more severe cases if there are medical reasons to avoid surgery. If an operation has to be delayed, either because of a long waiting list or because it is not convenient at the time, drugs can be used for temporary help. Some men close to retirement might want to wait until they stop work to have an operation. University or school teachers, politicians or other men with fixed vacations might prefer an operation during the summer and find temporary drug treatment helpful. Occasionally the urologist might suggest trying some drug treatment first to see if it helps a particular symptom before taking the irreversible step of an operation.
Although these drugs have relieved symptoms in men for whom an operation was not appropriate, there are still many men who are best advised that they do not really need any treatment. Also, drugs should ideally only be used after the prostate has been properly assessed and the tests have been done. Often this still means seeing a urologist but, partly as a result of the introduction of drugs to treat BPH, many GPs are becoming more involved in treating the prostate.