Common Standard Treatment of Benign Prostatic Hyperplasia (BPH) 

1) Medications

The two main medications for the management of BPH are alpha blockers and 5α-reductase inhibitors.

Alpha blockers (technically α1-adrenergic receptor antagonists) are the most common choice for initial therapy in the USA and Europe. Alpha blockers are used for BPH include doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin. Alpha blockers relax and smooth the muscle in the prostate and the bladder neck, thus decreasing blockage of urine flow. Common side effects of alpha blockers include orthostatic hypotension, (a head rush or dizziness when changing the body position suddenly), ejaculation changes, headache, nasal congestion, and general weakness. Side effects can also include erectile dysfunction.

The 5α-reductase inhibitors finasteride and dutasteride are another treatment option. These medications inhibit 5a-reductase, which in turn inhibits production of DHT, a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years. When used together with alpha blockers, a progression of BPH to acute urinary retention and surgery has been noted in patients with larger prostates. Side effects include decreased libido and ejaculatory or erectile dysfunction.

2) Alternative medicine

Herbal remedies are a commonly sought-after treatment for BPH, and several are approved in European countries, and available in the USA. Saw palmetto extract from Serenoa repens is one of the most commonly used and studied, having showed some promise in early studies. Later trials of higher methodological quality have shown it to be no better than placebo in both symptom relief and decreasing prostate size.

Other herbal medicines include beta-sitosterol from Hypoxis rooperi (African star grass) and pygeum (extracted from the bark of Prunus africana), while there is less substantial support for the efficacy of pumpkin seed (Cucurbita pepo) and stinging nettle (Urtica dioica) root.

3) Surgery

If medical treatment fails, and the patient elects not to try office-based therapies or the physician determines the patient is a better candidate for transurethral resection of prostate (TURP), surgery may need to be performed. In general, TURP is still considered the gold standard of prostate intervention for patients who require a procedure. This involves removing (part of) the prostate through the urethra. However after this endscopic surgery the ejaculations are dry and the person becomes sterile. For a male who wishes to be a father of a child this is not a good choice. Other side effects include erectile dysfunction, incontinence, damage, ulceration and more.