Herbs and Medicines

Are there any medicines that can help symptoms due to an enlarged prostate?

Rather than an operation, drugs, such as alpha blockers (e.g. tamsulosin, Flomax, Omnic, alfuzosin, Xatral, Cardura), relieve prostate symptoms by relaxing the muscle of the bladder neck and prostate and are useful in some patients with BPH — typically younger men with milder symptoms. The drugs reduce symptoms by about 25% or 4 to 6 points out of a total of 35 (see IPSS questionnaire) in more than half of men who take the drug. Symptoms are reduced within a few days. Side effects include drowsiness and headache in about 15% of men, reduced semen volume, and nasal congestion.

Finasteride or dutasteride can reduce the size of the prostate by about 20%, and improve symptoms in about 30 percent of patients who take it. Symptom scores improve by about 4 or 5 points out of 25. For example, if your symptom score was 16, then the symptom score would be about 11 or 12 out of 35 after 6 months or more of treatment. The chance of needing surgery for the prostate or being completely unable to pass urine ('acute urinary retention') is reduced by about 50%. To remain effective, the drugs need to be taken for the rest of your life. The side effects of finasteride include reduced volume of semen and altered semen quality, impaired erections, reduced libido, and occasional growth of the breast tissue.

Using finasteride and an alpha-blocker together is more effective than either drug alone to relieve symptoms and prevents BPH getting worse. The two-drug regimen reduced the risk of BPH progression in two out of three patients, compared to one-in three for an alpha-blocker alone and one in three for finasteride alone.

Drugs or medicines may not be enough, and more effective treatments such as TUNA, a TURP or the GreenLight PVP, which is a minimally invasive form of prostate treatment using a laser, may be more suitable.

What do I do about having to get up at night?

Getting up at night and passing urine becomes more common as one gets older. Surgery on the prostate may help if the bladder is not emptying completely because of obstruction by the prostate. However, the prostate is not always the cause of getting up at night. Usually, urine production stops at night, but this may not occur resulting in excess urine production at night. To detect this, keep a record of the total amount of urine passed during the day and night. If the amount of urine made at night is more than 25% of the total daily amount, then the following can help, but discuss with your doctor before adopting the advice below:

  • stop drinking 4 or more hours before going to bed
  • take a nap in the afternoon making sure the legs are elevated and the body is horizontal if possible.
  • wear tight compression leg stockings during the day

Your doctor should advise you further.

Drugs such as alpha blockers (eg tamsulosin or alfuzosin) can also be of benefit. These measures can be combined with a tablet to help encourage more urine production in the afternoon (a diuretic) or something to stop urine production at night (DDAVP). 

In some cases, the urgent need to pass urine occurs during the day and night. This problem may be due to overactivity of the bladder muscle and can be helped by avoiding caffeine and taking medicines. These medicines include tolterodine (Detrusitol) and oxybutynin (Lyrinel)

What about Saw Palmetto?

Saw palmetto (Serenoa repens) is a type of palm tree, also known as the dwarf palm. Its primary medicinal value lies in the oily compounds found in its berries. Most dietary supplements are composed of an extract from the berries or a berry powder.

Saw palmetto dietary supplements improve urinary flow, and reduce the frequency and urgency of urination in men with prostate enlargement. Saw palmetto is believed to inhibit the actions of testosterone in the prostate that cause prostate enlargement and interference with urinary flow.

Fatty acids and sterols found in Saw palmetto inhibit testosterone in the prostate. Sterols are also present in other herbs (such as pygeum bark, stinging nettle root, and pumpkin seed extract) used in treating symptoms of prostate enlargement.

Saw palmetto is commonly used in Germany and other parts of Europe and the United States, but less commonly in England. There have been concerns about the quantity of active agent in various preparations of Saw palmetto.