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Enlarged Prostate Medication Help

User
Posted 10 May 2021 at 12:10

Hi I've recently gone through the roller-coaster ride of a PSA tests, MRI scan and finally a biopsy. My PSA was slightly elevated. The good news is that I don't have prostate cancer. However I was getting up at night between 2 and 4 times for a wee. Last week  I was prescribed Alpha Blockers by my GP, so far they partially work but still getting up about twice a night. Should I give it more time for the medication to work?  My prostate is graded as size 2. I wondered if I should go back to my GP and ask for prostate shrinking medication? I also have a problem when I'm driving distances (dull pain) and I'm guessing it's the pressure on my prostate. 

User
Posted 10 May 2021 at 13:26

Did the alpha-blocker make any difference?
Was your pee flow rate slow, and did it speed it up?
When you pee at night, do you pee only a small volume?
What time of day did you take the alpha-blocker?
They are fast acting - you'd know in a day or two if they are going to work.

Prostate shrinking medications are the 5𝞪-reductase inhibitors, Finasteride or Dutasteride. These are hormone therapy medications, having a few of the same side effects of the prostate cancer hormone therapy drugs. They prevent the production of Dihydrotestosterone (DHT), but you will still have testosterone (unlike the prostate cancer hormone therapy drugs). DHT is used for around 4 things:
∙ Prostate operation and growth (dry orgasms),
∙ Seminal vesicle operation (dry orgasms),
∙ Hair follicles (some loss of body hair, but conversely reversal of balding),
∙ Some level of libido, but not all of it (may cause problems getting sufficiently aroused for an erection).

The 5𝞪-reductase inhibitors shrink your prostate during first 6 months.

User
Posted 10 May 2021 at 14:00

The flow rate is definitely better and the volume is good, but ideally I'd like to not get up in the night at all. I take the alpha blockers after breakfast around 8am. I've cut back on caffeine, and generally dont have a drink after 7pm. I'm careful now with what I eat and rarely drink alcohol. I exercise, cycle and walk. I will give the medication a go, months supply. If there's not much improvement I will go back to the GP. I thought a grade 2 size prostate isn't huge but I'm guessing it all depends what it's pressing on. 

User
Posted 10 May 2021 at 17:08
Sounds like you would benefit from bladder retraining more than meds. Ask the GP for a referral to local incontinence service for advice and help.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 May 2021 at 19:03

Since your issue is more at night than during the day (or at least you didn't say there was a problem during the day), you might want to trying taking the alpha blockers with the last meal of the day, instead of the first. Tamsulosin doesn't tend to last 24h, and by taking it later in the day, you will have a higher concentration working overnight when you have the problem. Most preparations of Tamsulosin must be taken with or just after food and not on an empty stomach, because this is how the slow release mechanism is designed to work, but check the leaflet which comes with yours. Also, be careful if you take other meds which can reduce blood pressure at the same time, such as PDE5 inhibitors (Sildenafil/Viagra, Tadalafil/Cialis), because there's a risk that taking these all together might produce a temporary drop in blood pressure which could make you faint.

I'm not expert on BPH staging, but I thought the grade was more about the resulting symptoms than the size. While larger prostates tend to generate worse symptoms, that's not always the case. (My prostate was 97cc, 3x normal size, but didn't cause any symptoms. A cystoscopy showed it generating quite a large dent into the bottom of the bladder though.)

User
Posted 10 May 2021 at 20:13

It is more of an issue at night for me, so I could try taking the medication later on in the day. I do take it after breakfast but for me that could  be as early as 7.30am. One benefit so far is my blood pressure had lowered to a good rate. 

 
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