Prescription medicines and prostate conditions

Read this page as education, then stop

This article names kinds of prescription medicines so that a clinic visit is easier to follow. It does not sell medicines, choose a dose, or replace a prescriber. Do not start, stop, or change a prescription because of something you read here. Google Ads and U.S. law place extra limits on promotion of prescription drugs. This page is not an advertisement for any drug, and it should be reviewed again before any paid campaign sends people to it.

Medicines for bothersome enlargement

MedlinePlus describes three jobs medicines can do for mild to moderate BPH symptoms: slow further growth, shrink the prostate, or relax muscle so urine flows more easily. Sometimes two medicines are combined. The page you are reading does not list brand names or doses, because the right choice depends on symptom scores, prostate size, sexual side effects you want to avoid, and other diseases.

Medicines that relax smooth muscle often act within days to weeks and do not shrink the gland. Medicines that block the conversion of testosterone to DHT can shrink the gland over months and can also change ejaculation and sexual function. A clinician should match those tradeoffs to your priorities. If symptoms are severe, or if you cannot urinate, a medicine is not a substitute for urgent care.

Acute bacterial prostatitis is treated with antibiotics, and it can require hospital care. Chronic pelvic pain is different and often is not solved by a long antibiotic course. Do not use leftover antibiotics for urinary burning.

Some nonprescription cold and allergy medicines can make urinary blockage suddenly worse. That interaction is a reason to ask before you treat a cold, not a reason to abandon every medicine you were prescribed for the prostate.

What large trials found about finasteride and dutasteride

Finasteride and dutasteride are prescription drugs that lower DHT. The National Cancer Institute’s patient prevention summary describes two trials:

• The Prostate Cancer Prevention Trial studied finasteride in healthy men age 55 and older. Fewer prostate cancers were found in the men assigned to finasteride than in the men who were not. The number of deaths from prostate cancer was the same in both groups. Sexual side effects and breast enlargement were more common on finasteride. The trial initially suggested more aggressive tumors in the finasteride group. A later analysis did not find that those men had more aggressive tumors.
• The REDUCE trial studied dutasteride in men ages 50 to 75 who were at higher risk. Fewer prostate cancers were found on dutasteride. The drop was in less aggressive cancers. The number of more aggressive cancers was not lower. Sexual side effects, less semen, and breast enlargement were more common.

The National Cancer Institute says these drugs lower the risk of a prostate-cancer diagnosis and that it is not known whether they lower the risk of dying of prostate cancer. That is a narrow finding. It is not an instruction to take either drug. It is not a supplement claim. Men who already take one of these drugs for enlargement should not stop it, and men who do not take it should not start it to “cover” cancer risk, unless a prescriber recommends that after discussing side effects and the missing effect on deaths.

Hormone therapy for cancer is a different subject

Medicines that lower male hormones are also used to treat some prostate cancers, especially disease that has spread or that is being treated with radiation in higher-risk situations. Intermittent schedules and continuous schedules have been compared in trials. This page does not declare a winner. An old post on the previous website said a meeting presentation had shown worse survival with intermittent therapy in metastatic cancer. That specific claim is not repeated here, because this rebuild did not re-review the trial report and will not pass along a conference summary as if it were current guidance. Ask your oncologist or urologist which schedule, if either, applies to your cancer, and what the side effects mean for bone, heart, and sexual health.

Questions for the prescriber

• What symptom or cancer outcome is this medicine expected to change, and how long before we can tell?
• What side effects are common, and which ones should make me call?
• How will we know it is not working?
• Does it change PSA, and how should we interpret the next test?
• What nonprescription drugs and supplements should I avoid while I take it?