Medical Treatment for Enlarged Prostate

Medical treatment for benign prostatic hypertrophy (BPH) includes a series of drugs that can help to reduce symptoms.

BPH is one of the most common diseases in men that cause symptoms of the urinary tract. These symptoms can be very annoying in up to 30% of men over 65 years old. The causes of the disease are due to several factors and the ones associated with it are age, prostatic specific antigen (PSA) and the volume of the prostate.

These specific risk factors can help to identify the group of patients with an increased risk of progression, that are candidates for treatment in an early stage. As the patient ages, and the intensity of the initial symptoms worsen, there is an urgent need for surgery.

Proper management of these patients aims to decrease symptoms, improve their quality of life and avoid complications (urinary retention or need for surgery).

The management may include expectant treatment, medical treatment, surgery, the prostatic endoprosthesis and focal therapy. We will focus on medical treatment in this article.

Expectant treatment

It is a good option for patients with mild or moderate to severe symptoms that do not influence that much in patient´s quality of life. In this type of management, our specialists will provide information, perform regular checkups and recommend lifestyle changes.


Medical treatment

Alpha-blockers are of choice in patients with symptoms of moderate to severe without criteria for progression. They improve the symptoms and the rate of urinary flow. However, they have not proved to reduce the size of the prostate or prevent the onset of acute urine retention. Its onset of action is fast and its effectiveness is visible one month after starting treatment. All alpha-blockers have similar efficacy and patients generally tolerate them well. Side effects include dizziness, orthostatic hypotension, and retrograde ejaculation (more common with silodosin).



5-alpha-reductase inhibitors are of choice in patients with large prostates (> 30 g). In these patients, the incidence of acute urinary retention and the need to resort to surgery after prolonged use for 2-4 years decrease. The onset of action of these drugs is slow, they need between 6-12 months for this effect on the prostate to translate into an improvement in urinary symptoms. Therefore, they are only suitable for long-term treatment. Dutasteride and finasteride have similar efficacy and safety profile (impotence, decreased libido, ejaculation disorders, gynecomastia).


Combination therapy (alpha-blockers + 5-alpha-reductase inhibitors) is indicated when there are moderate-severe symptoms, the prostate volume is large and the prostate-specific antigen or PSA> 1.4 or 1.5 ng / ml, for all of them being prognostic factors of progressive disease.


You might also want to read: Benign Prostatic Hypertrophy


At the Harley Street Hospital, we have some of the best specialists to treat benign prostatic hypertrophy. Book an appointment to get a checkup.

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