Drug therapy for benign prostate enlargement

Which drugs are suitable for the treatment of benign prostate enlargement depends primarily on the type and severity of the symptoms. 

Herbal preparations 

In the case of mild symptoms, even herbal medicines can alleviate the symptoms. These include extracts from saw palmetto fruits, nettle roots, pumpkin seeds or rye pollen. 


If the symptoms are more pronounced or the impairment is increasing, alpha-blockers are primarily used. Tamsulosin is the most commonly prescribed drug; alfuzosin, doxazosin, silodosin and terazosin are also approved. They facilitate bladder emptying by reducing muscle tension in the prostate and bladder neck. The symptoms usually improve after a few days. However, alpha-blockers can neither stop the progression of enlargement nor reduce prostate volume in the long term.

Possible side effects include dizziness, fatigue and low blood pressure. In some cases, a so-called retrograde ejaculation (backward ejaculation) may occur.

5-Alpha reductase inhibitors 

5-Alpha-reductase inhibitors slow down the conversion of testosterone to dihydrotestosterone (DHT), thereby inhibiting prostate cell growth.  The volume of the prostate decreases and the pressure on the bladder and urethra decreases. However, their effect is very slow and it can take several months for the symptoms to improve. Especially men with a greatly enlarged prostate benefit from therapy with alpha reductase inhibitors. Finasteride and dutasteride are available in Germany.

The side effects are generally low, but some patients report a loss of libido and potency. 

Combination treatment 

The combination therapy of alpha-blockers and 5-alpha-reductase inhibitors takes advantage of the different mechanism of action of both substance classes. Both drugs are used together to alleviate symptoms as quickly as possible and at the same time inhibit further prostate growth. A combination treatment is suitable for men with very pronounced symptoms and a significantly enlarged prostate.

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