What can you expect when treating BPH with medication?

Men who have been diagnosed with an enlarged prostate (benign prostatic hyperplasia, BPH) have many treatment options including foods to shrink the prostate, beta-sisterol supplements and other natural solutions we’ve written about.

But medications and invasive and noninvasive medical procedures are also available. When medications are being considered, patients often want to know how one drug performs against another so they can make a choice that best suits their needs. Here we look at Proscar compared to Flomax for treating enlarged prostate.

What is Proscar?

Proscar (finasteride) is in a drug class called 5-alpha reductase inhibitors, which means it works by blocking the activity of an enzyme (5-alpha reductase) to transform testosterone to dihydrotestosterone (DHT). This is important because DHT plays a significant role in making the prostate enlarge.

Use of Proscar reduces the amount of DHT in the body, which in turn can cause the prostate to shrink and allow urine to flow more easily.

What is Flomax?

Flomax (tamsulosin) is an alpha blocker which, unlike Proscar, helps men with an enlarged prostate not by shrinking the prostate but by relaxing the muscles in the gland as well as in the bladder. This combined effort improves urine flow, urinary frequency and urinary urgency associated with BPH. Therefore, both Proscar and Flomax treat an enlarged prostate and its symptoms in different ways but with similar results.

What can you expect when taking Proscar?

• Proscar is an oral medication typically taken once daily at the same time every day.
• Proscar can be taken alone or along with other medications designed to reduce symptoms of an enlarged prostate.
• Use of Proscar may slightly increase a man’s risk of developing advanced prostate cancer.
• It may take as long as six to 12 months before noticing an improvement in symptoms.
• Side effects may include reduced libido, increased hair growth, and a reduction in the amount of semen released during ejaculation. Less common but serious side effects may include breast enlargement or tenderness, nipple discharge, breast lumps, testicle pain, and an inability to urinate.

Although the Food and Drug Administration has required that the maker (Merck) of Proscar and Propecia (another form of finasteride) include warning labels on their products about the possibility of erectile dysfunction, semen quality, and other sexual problems associated with use of these drugs after discontinuing them, evidence to support this measure remains uncertain.

What can you expect when taking Flomax?

• Flomax is an oral medication usually taken once daily, 30 minutes after the same meal every day.
• Side effects may include sudden drop in blood pressure, which could result in fainting or dizziness; drowsiness; runny or stuffy nose; ejaculation problems; rarely, priapism (an erection lasting 4 or more hours) may occur.
• Before taking Flomax, tell your doctor or pharmacist if you have any medication conditions, especially low blood pressure, cataracts or glaucoma.
• It may take up to one month before you experience symptom improvement.

What does the research show?

A number of studies have compared the effects of treatment with Proscar and Flomax for enlarged prostate. One 2015 study involved 470 men who took finasteride and 230 men who were given tamsulosin. The authors found that after 45 months of follow-up, long-term use of finasteride worsened erectile dysfunction and reduced testosterone levels, but tamsulosin did not.

In another study, investigators compared the efficacy of the two drugs in the treatment of symptomatic enlarged prostate in 70 men ages 50 to 80 years. After six months of treatment, there was a significant improvement in International Prostate Symptom Scale and maximum urinary flow rate (Qmax) among men in both groups. However, men who took tamsulosin demonstrated improvement faster than those in the finasteride group.

Should you use Proscar or Flomax for enlarged prostate?

Although both Proscar and Flomax treat an enlarged prostate, men can expect differing experiences when taking these medications. Patients need to review the pros and cons of each medication with their physician and discuss which medication is more suitable for their lifestyle and situation.

Sources:

1. Food and Drug Administration. Questions and answers: Finasteride label changes

2. Hasan M et al. Comparison of efficacy between tamsulosin and finasteride on symptomatic benign prostatic hyperplasia. Mymensingh Medical Journal 2007 Jul; 16(2): 154-59

3. Traish AM et al. Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia. Hormone and Molecular Biology and Clinical Investigation 2015 Sep; 23(3): 85-96