Sunday, February 25, 2018

Doc, what to do about this BPH?

Benign prostatic hyperplasia (BPH), also called benign enlargement of the prostate (BEP), is a benign increase in size of the prostate.


Mark Fraser

 For some men, their BPH may not be too bothersome and together with their doctor they may decide to wait and watch things for a while as symptoms sometimes improve without anything being done rather than start a treatment that could give you side effects and make you more miserable. In other words, in some cases it’s “better the devil you know than the devil you don’t”. Many men with mild to moderate symptoms have found that simple lifestyle adjustments take the BPH bother away. Some of these include reducing your intake of fluids after supper as well as limiting caffeine and alcohol intake. If you decide on treatment for your BPH, tablets are usually the first thing that would be tried. Your doctor will advise you as to what is best in your situation. You will more than likely be given tablets called Alpha Blockers (pronounced “al-fa-block-ers”), 5-ARIs (pronounced “5 -al-fah-re-duck-tase-in-hib-it-ors”) or tablets with a combination of both medications like Jalyn. Keep in mind, none of these medications work for everyone.

Alpha Blockers with names like Terazosin (Hytrin), Tamsulosin (Flomax), Doxazosin (Cardura), Alfuzosin (Uroxatral), and Silodosin (Rapaflo) relax muscles in the prostate and bladder neck that sometimes get tight, preventing easy urination. 

It is important to note that one side effect of Alpha Blockers is they can lower your blood pressure causing dizziness that could lead to falls. They were originally used to treat high blood pressure. The alpha-1 blockers work quickly, in days to weeks, but some may require some patience, as doses are started low and have to be increased slowly to avoid lowering your blood pressure too much. For example Terazosin is usually started at 1 milligram (mg) to be taken at bedtime, and then gradually increased. This process of gradually increasing is called “titration” and may be frustrating for you because you will need to wait to find the correct dose for you.

If you were prescribed an Alpha Blocker, your doctor may have also suggested you go slowly when moving from a lying to completely standing position (don’t just jump out of bed ) as sudden changes from a lying to a sitting position could make you dizzy possibly leading to falls. Better to sit up at side of bed and make sure your head is clear before standing.

If you are planning to have cataract surgery, recommendations are that you let the doctor who gave you the prescription for the Alpha Blocker know your plan ahead of time as there may be a risk of “Intra-operative Floppy Iris Syndrome” that can affect your vision. For more on this, just send a blank email to

5- ARIs with names like Finasteride (Proscar) and Dutasteride (Avodart) are prescribed based on the size of your prostate. They shrink prostate tissue to help improve your symptoms. Propecia (the only FDA approved oral medication to treat male-pattern baldness) contains a low dose of Finasteride. There may be an added benefit for some men to watch their hair grow as their symptoms improve. There are reported side effects however related to sexual health and it usually takes longer to see results.

Another important thing to note is 5-ARIs can lower your PSA (Prostate Specific Antigen) blood test result by ½ in about 3-6 months. Because your doctor knows a high PSA result could mean prostate cancer, he will be looking closely at your PSA result to make sure that you are not falsely reassured by a low result.

 Next week, “what if they tablets don’t work or stop working?”.

Dennis is an Oncology trained Nurse and Cancer Consultant with over 20 years experience. He has a keen interest in Men’s Health with a focus on prostate disease, prostate cancer and prostate cancer risk assessment.


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This Information is intended to be used as general information only and should not replace consultation with healthcare professionals. Consult a qualified healthcare professional before making medical decisions or if you have questions about your individual medical situation.