Drug therapy for benign prostatic hyperplasia
Which medications are considered for the treatment of benign prostatic hyperplasia depends primarily on the type and severity of the symptoms.
Herbal preparations
In the case of mild symptoms, herbal medicines can already alleviate the symptoms. These include extracts from saw palmetto fruit, nettle roots, pumpkin seeds or rye pollen.
Alpha Blocker
When symptoms are more pronounced or impairment increases, alpha-blockers are primarily used. Tamsulosin is the most commonly prescribed; alfuzosin, doxazosin, silodosin, and terazosin are also approved. They facilitate bladder emptying by reducing muscle tension in the prostate and bladder neck. Improvement in symptoms usually occurs after a few days. However, alpha-blockers cannot stop the progression of enlargement nor reduce prostate volume in the long term.
Possible side effects include dizziness, fatigue and low blood pressure. In some cases, a so-called retrograde ejaculation (backward ejaculation) may occur.
5-alpha-reductase inhibitors
5-alpha-reductase inhibitors slow down the conversion of testosterone to dihydrotestosterone (DHT) and thus prevent cell growth in the prostate. The volume of the prostate is reduced and the pressure on the bladder and urethra is relieved. However, their effect sets in very slowly; sometimes it can take several months before the symptoms improve. Men with a severely enlarged prostate in particular benefit from therapy with alpha-reductase inhibitors. Finasteride and dutasteride are available in Germany.
Overall side effects are mild, but some patients report loss of libido and potency.
Combination treatment
The combination therapy of alpha-blockers and 5-alpha-reductase inhibitors takes advantage of the different mechanism of action of the two substance classes. The two drugs are used together to relieve symptoms as quickly as possible and at the same time inhibit further growth of the prostate. Combination treatment is considered for men with very severe symptoms and a significantly enlarged prostate.
