Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland that affects the majority of men with advancing age — prevalence is approximately 50% in men aged 51–60 and over 90% in men over 80. BPH compresses the urethra as it traverses the prostate, producing lower urinary tract symptoms (LUTS): weak urinary stream, hesitancy, dribbling, incomplete bladder emptying, nocturia, frequency, and urgency. These symptoms significantly impair quality of life. Pharmacological treatment targets the two main mechanisms: the dynamic component (smooth muscle tone in the prostate and bladder neck — treated with alpha-1 adrenoceptor blockers) and the static component (prostate volume driven by DHT — treated with 5-alpha reductase inhibitors).
Alpha-1 blockers (tamsulosin, alfuzosin, doxazosin, terazosin) relax smooth muscle in the prostate stroma and bladder neck, improving urinary flow within days of starting treatment. They do not reduce prostate size. 5-Alpha reductase inhibitors (finasteride, dutasteride) reduce DHT-driven prostate growth, shrinking the prostate over 3–6 months and ultimately reducing BPH progression and urinary retention risk. For men with small to moderate prostates, alpha blockers alone are first-line. For men with larger prostates, 5-ARIs alone or combination therapy may be preferred.
Prostate Health Medications at Lucas Clinic
- Flomax (Tamsulosin) — Rx; 0.4 mg capsules; selective alpha-1A blocker for BPH; relaxes prostate/bladder neck; not a BP medication; risk of IFIS (warn ophthalmologist before cataract surgery); first-dose orthostatic hypotension
- Propecia / Proscar (Finasteride) — Rx; 1 mg (Propecia — male pattern baldness) or 5 mg (Proscar — BPH) tablets; 5-alpha reductase inhibitor; reduces DHT; continuous daily use required; results lost if stopped; teratogenic — women of childbearing potential must not handle crushed/broken tablets
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