Prostate Enlargement

Background

A man’s prostate becomes larger as he ages, a condition known as benign prostatic hypertrophy, or BPH. It’s usually not a serious or life-threatening condition, but it can cause problems with urinating, primarily in men age 50 and older. Often, lifestyle changes can be enough to provide relief, but if those don’t work, then medications may be necessary.

To help you and your doctor choose the right BPH medicine if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 17-page report you can access at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Indications

Many men with BPH will either have no symptoms or symptoms that are mild and not that bothersome. But for millions of others, the urinary problems caused by BPH can interfere with their quality of life. Some men with BPH, for example, feel the urge to get up several times throughout the night to urinate, which can interrupt their sleep and leave them tired and groggy. If you have urinary problems due to BPH, lifestyle changes can often provide relief and should be tried before medication. (See below for tips.)

Lifestyle changes that can ease symptoms of BPH

  • Urinate when you first feel the urge; don’t wait.
  • Do not rush urination. Take your time and relax before, during, and after to give your bladder extra time to empty if the stream is slow or intermittent.
  • Practice “double-voiding”: Urinate as much as possible, relax for a moment, and then go again.
  • Urinate before car trips, meetings, or movies.
  • Spread fluid intake throughout the day and reduce it before bedtime, especially coffee, tea, or other caffeinated beverages. Do not avoid fluid intake to reduce the need to urinate. That can cause dehydration.
  • Drink alcohol and caffeine in moderation.
  • Avoid decongestant and antihistamine medicines when possible.
  • If you take a diuretic (a type of high blood pressure pill), ask your doctor if you can take a lower dose or a different drug.
  • If you have diabetes, controlling blood sugar can reduce frequent urination.

Our Recommendations

You should see a doctor if you have urinary problems. The symptoms of BPH can be similar to the symptoms of prostate cancer, so it’s important to get an accurate diagnosis. You should also contact your doctor immediately if you have a fever or chills; pain in your back, side, or abdomen; cloudy or bloody urine; or pain when urinating. Those could be signs of serious complications that require medical attention.

If you have urinary problems due to BPH, lifestyle changes can often provide relief and should be tried first. Those include going to the bathroom when you first feel the urge; reducing or eliminating your intake of alcohol, caffeine, antihistamines, and decongestants; and limiting your fluid intake before bedtime.

If your symptoms persist or worsen, the next step is usually to consider medication. Two classes of drugs are commonly used to treat prostate enlargement: alpha-blockers and 5-alpha-reductase inhibitors. Alpha-blockers are generally used first because they act fast, relieving urination problems in a matter of days or weeks, while reductase inhibitors can take several months to provide relief. Sometimes the two types of drugs are used in combination.

Taking the evidence for effectiveness, safety, cost, and other factors into account, if you and your doctor decide that a drug is appropriate to treat your symptoms of an enlarged prostate, we have chosen the following alpha-blocker as a Consumer Reports Best Buy Drug:

Doxazosin

It’s a good first option. We picked it as our Best Buy because it has a long track record of being both safe and effective. It’s also available as an inexpensive generic drug, costing $8 or less for a month’s supply. The savings would be significant vs. taking one of the costly brand-name alpha-blockers, which can run more than $100 per month.

If doxazosin doesn’t work for you, you might try another alpha-blocker, terazosin. Or you and your doctor might want to consider adding a reductase inhibitor to your regimen. In that case, we recommend finasteride. It is the only reductase inhibitor available as a generic, so it costs significantly less than a brand-name drug. In addition, the combination of finasteride and doxazosin has been proven to delay the progression of BPH symptoms.

This report was last updated in May 2012.

Cost Comparison

Note: If the price box contains a

, that indicates the dose of that drug is likely available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Generic Name, Form, and Dose

Brand Name1

Number of Pills per Day2

Average Monthly Cost3

Alpha-blockers

Alfuzosin 10 mg sustained-release tablet

Generic

One

$82

Alfuzosin 10 mg sustained-release tablet

Uroxatral

One

$161

Doxazosin 1 mg tablet

Generic

One

$8

Doxazosin 1 mg tablet

Cardura

One

$74

Doxazosin 2 mg tablet

Generic

One

$8

Doxazosin 2 mg tablet

Cardura

One

$75

Doxazosin 4 mg tablet

Generic

One

$7

Doxazosin 4 mg tablet

Cardura

One

$74

Doxazosin 8 mg tablet

Generic

One

$7

Doxazosin 8 mg tablet

Cardura

One

$73

Doxazosin 4 mg sustained-release tablet

Cardura XL

One

$81

Doxazosin 8 mg sustained-release tablet

Cardura XL

One

$86

Prazosin 1 mg capsule

Generic

Two

$14

Prazosin 2 mg capsule

Generic

Two

$16

Prazosin 5 mg capsule

Generic

Two

$20

Silodosin 4 mg capsule

Rapaflo

One

$163

Silodosin 8 mg capsule

Rapaflo

One

$159

Tamsulosin 0.4 mg capsule continuous-delivery

Generic

One

$78

Tamsulosin 0.4 mg capsule continuous-delivery

Flomax

One

$183

Terazosin 1 mg capsule

Generic

One

$26

Terazosin 2 mg capsule

Generic

One

$24

Terazosin 5 mg capsule

Generic

One

$24

Terazosin 10 mg capsule

Generic

One

$29

5-alpha-reductase inhibitors

Dutasteride 0.5 mg capsule

Avodart

One

$146

Finasteride 5 mg tablet

Generic

One

$75

Finasteride 5 mg tablet

Proscar

One

$134

1. "Generic" indicates that it’s the generic version of the drug.

2. As typically prescribed.

3. Prices reflect nationwide retail average for March 2012, rounded to the nearest dollar if you were to pay the cash price. Information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations. We omit drugs with a low number of prescriptions (less than 20) because the prices are unreliable and these medications might be difficult to find because pharmacies often won’t stock drugs if there is little or no demand for them.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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