• Herbal medications are sometimes taken by men. Saw palmetto is the most widely used, and appears to cause little harm. These may have a mild beneficial effect, but there is little scientific proof that they work better than a placebo.
• Alpha Blockers are the most commonly prescribed medications for BPH. They help about 50% of patients, probably by relaxing the smooth muscle of the prostate and bladder neck. The different medications include terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol) and tamsulosin (Flomax), and seem to differ slightly in side effects, but not in potency. They are lifetime medications, and all can cause some minor fatigue, nasal congestion and retrograde ejaculation (semen flows into the bladder with ejaculation). Rarely, there is the potential to cause a drop in blood pressure, which can lead to dizziness when standing, or even fainting. Also, their use has been associated with making cataract surgery more difficult, so if you have cataracts, your use of these meds should be discussed with your ophthalmologist.
• 5 alpha Reductase Inhibitors are medications that block the conversion of testosterone to dihydrotesterone (DHT) in the prostate, thus “shrinking” the gland. It takes 3-6 months to have maximum effect, and the PSA drops by 50% during this time. Side effects include reversible mild breast enlargement or ED. There are 2 medications, finasteride (Proscar) or dutasteride (Avodart) that appear to have similar effectiveness, although dutasteride is more potent.  Like the alpha blockers, they are lifetime medications, and  they help about 50% of patients, especially in those men with larger prostates (over 30 grams).
• Combination therapy, using both alpha blockers and 5 alpha reductase inhibitors, is safe and on occasion may be more helpful than using either drug alone.

• Thermotherapy (microwave) is an in-office procedure that heats the prostate. The Prolieve system uses a combination of balloon dilation with heat, thus decreasing the need for a post procedure catheter to about 10%. It is well tolerated, has a rapid recovery (24 hours typically) and gives improvement in about 75% of men, allowing them to discontinue medications and avoid surgery.
• TUNA (Transurethral Needle Ablation) is done in the office also, using needles that puncture the urethra and heat the prostate. It is not tolerated as well as the Prolieve, but appears to have similar effectiveness.

• Lasers are the least invasive surgical option to relieve prostate obstruction. An anesthetic is required, but there is very little pain or bleeding afterwards and there is a rapid return to normal acivities usually within a week. While there are many types of lasers, the most commonly used are the holmium (HoLAP) and the KTP (GreenLight), with similar effectiveness and side effects.
• TURP (Transurethral Resection of the Prostate) is the standard but most invasive way to open the prostate. Under an anesthetic, a special scope is placed in the urethra, and an electrical loop is used to cut the prostate tissue into small pieces, which are then flushed out of the bladder. This requires 2-3 days in the hospital with more bleeding and discomfort than any other procedure. Typical recovery time to normal activities is 3-6 weeks.

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