What medications are used to treat prostate issues, including benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 26, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Medications for Prostate Issues

For benign prostatic hyperplasia (BPH), alpha-blockers (tamsulosin, alfuzosin, doxazosin, silodosin, terazosin) and 5-alpha reductase inhibitors (finasteride, dutasteride) are the primary medications, with combination therapy recommended for men with enlarged prostates to reduce disease progression and prevent complications. 1

Benign Prostatic Hyperplasia (BPH) Medications

Alpha-Blockers

  • Alpha-blockers are first-line therapy for moderate to severe LUTS/BPH, providing rapid symptom relief by relaxing prostatic smooth muscle and relieving bladder outlet obstruction 1
  • Available options include alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin, all with similar clinical effectiveness but different side effect profiles 1
  • These medications typically improve AUA Symptom Index scores by 4-7 points compared to 2-4 points with placebo 1
  • Side effects include orthostatic hypotension, dizziness, fatigue, ejaculatory problems, and nasal congestion 1
  • Tamsulosin has lower risk of orthostatic hypotension but higher risk of ejaculatory dysfunction compared to other alpha blockers 1
  • Alpha-blockers can cause Intraoperative Floppy Iris Syndrome (IFIS) during cataract surgery; patients should inform their ophthalmologist before surgery 1, 2

5-Alpha Reductase Inhibitors (5-ARIs)

  • 5-ARIs (finasteride, dutasteride) are indicated for men with prostatic enlargement (>30cc volume, PSA >1.5ng/mL, or palpable enlargement on DRE) 1, 3
  • These medications reduce prostate size by inhibiting conversion of testosterone to dihydrotestosterone 1
  • Finasteride is indicated to improve symptoms, reduce risk of acute urinary retention, and reduce need for surgery including TURP 3
  • 5-ARIs take 3-6 months to show full effect, unlike alpha-blockers which work more quickly 1
  • Common side effects include sexual dysfunction, including decreased libido, erectile dysfunction, and ejaculatory disorders 3

Combination Therapy

  • Combination of alpha-blocker and 5-ARI is recommended for patients with enlarged prostates to prevent disease progression and reduce risks of urinary retention and future prostate surgery 1, 3
  • The combination of finasteride with doxazosin is FDA-approved to reduce risk of symptomatic progression of BPH 3
  • Combination therapy is more effective than either medication alone for preventing clinical progression in men with larger prostates 1
  • Side effects of combination therapy are cumulative from both medication classes 3

PDE5 Inhibitors

  • Tadalafil (5mg daily) can be used for men with LUTS/BPH, especially those with concurrent erectile dysfunction 1
  • Sildenafil has also shown efficacy in improving LUTS/BPH symptoms, particularly nocturia when dosed at 50mg at night 4
  • Combination of tadalafil with alpha blockers is not recommended as it offers no advantage over either agent alone 1

Other Medication Options

  • Anticholinergics may be used alone or with alpha blockers for patients with predominant storage symptoms 1
  • Beta-3-agonists in combination with alpha blockers may be offered to patients with moderate to severe predominant storage LUTS 1

Prostate Cancer Medications

  • Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced or metastatic prostate cancer 5
  • ADT options include:
    • LHRH agonists (leuprolide, goserelin)
    • LHRH antagonists (degarelix)
    • Anti-androgens (bicalutamide, enzalutamide, apalutamide)
  • Newer hormonal agents for castration-resistant prostate cancer include abiraterone acetate 5
  • Chemotherapy (docetaxel, cabazitaxel) is used for metastatic disease 5

Prostatitis Medications

  • Acute bacterial prostatitis is treated with antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole)
  • Chronic bacterial prostatitis requires longer courses of antibiotics (4-6 weeks)
  • Chronic prostatitis/chronic pelvic pain syndrome may be treated with alpha-blockers, anti-inflammatories, and muscle relaxants

Treatment Algorithm for BPH

  1. For mild symptoms: Watchful waiting with lifestyle modifications (reducing fluid intake at bedtime, decreasing caffeine and alcohol) 1
  2. For moderate to severe symptoms:
    • Start with alpha-blocker (tamsulosin, alfuzosin, doxazosin, silodosin, or terazosin) 1
    • For enlarged prostate (>30cc, PSA >1.5ng/mL): Add or use 5-ARI (finasteride or dutasteride) 1
    • For storage symptoms: Consider adding anticholinergic or beta-3-agonist 1
    • For concurrent erectile dysfunction: Consider PDE5 inhibitor (tadalafil 5mg daily) 1

Important Considerations and Pitfalls

  • Alpha-blockers provide faster symptom relief (within weeks) while 5-ARIs take 3-6 months for full effect 1
  • 5-ARIs reduce PSA levels by approximately 50%; PSA values should be doubled for cancer screening purposes 3
  • Patients on alpha-blockers should be monitored for orthostatic hypotension, especially when initiating therapy 2
  • Combination therapy has more side effects than monotherapy but provides better long-term outcomes in preventing disease progression 1
  • PDE5 inhibitors should not be used with nitrates due to risk of severe hypotension 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

Should I stop Eliquis (apixaban) in a patient with benign prostatic hyperplasia (BPH) who has a Foley catheter with bloody output?
What is the best management approach for an 89-year-old male with BPH, slow stream, nocturia, PSA 5.8, and a small nodule on DRE, currently on alpha-blocker and 5-alpha-reductase inhibitor therapy?
What is the best initial diagnostic step for a 65-year-old male with progressive lower back pain, radiating to the legs, and a history of prostate (prostate cancer) cancer?
What treatment is recommended for a male with urinary frequency, weak urinary stream, prolonged dribbling, and erectile dysfunction, who is taking hydrochlorothiazide (HCTZ), norvasc (amlodipine), and atorvastatin, with impaired fasting glucose and mildly elevated Blood Urea Nitrogen (BUN) levels?
What is the best course of action for an 88-year-old male with Benign Prostatic Hyperplasia (BPH) and nocturia, currently stable on Flomax (tamsulosin) and behavioral modifications, with a history of Prostate Cancer (PCa) treated with Trelstar (triptorelin) injections?
What is Nicorandil?
Is there a risk associated with using propofol in patients with a history of hypoxic-ischemic encephalopathy (HIE)?
What is the next course of action for a patient with a history of frequent UTIs, recent completion of cefuroxime axetil for UTI, episode of hematuria, and benign prostate neoplasm?
Should faropenem (generic name) be continued for a patient with pyelonephritis and urosepsis who has recovered from shock and is planned for discharge?
What is the treatment for pancolitis?
What oral antibiotic regimen is suitable for a patient who has recovered from complicated Urinary Tract Infection (UTI) with pyelonephritis and shock after 14 days of meropenem?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question