Best Medication for BPH

[jonkobeck]

I have BPH and all its symptoms. Have had it for a while but the frequent urination is worsening to the point where I can't drive home without stopping for a piss (unless I remain dehydrated) - I am feeling like its time to treat and will ask my doc for something. Is there a preferred medication, with the least side effects? Is Cialis daily worth a try?

 

[TheOldFart]

Cialis and doxazosin are probably the best without bad sexual side effects. I don't think that anyone ever complained about the sexual side effects of Cialis. I've been using 8mg of doxazosin daily for about 10 years and it works pretty well. I've read that it is as effective as finasteride, except that doxazosin won't shrink the prostate like finasteride can. I also tried 8mg of doxazosin plus 2.5mg of Cialis and it was better than just doxazosin alone, but not enough to justify the cost of Cialis, even though I was splitting the 5mg pills.

 

[jonkobeck]

Thanks . Its coming time I need to be on something for the frequent urination. ITs interfering with my driving. I cant drink a bottle of water in the car without stopping (twice!) in an hour. I will see what the Uro says. Still waiting for my most recent PSA results. Was .8 a couple months back. I know thats low, but its always been .4

 

[Aces]

Flomax is more prostate specific than doxozosin from what my Uro said.
I use flomax and get no sexual side effects; maybe slightly less ejaculation but nothing bothersome.
5 mgs of cialis in the morning and flomax at night before bed. Its a good combo.

 

[TheOldFart]

There are several studies comparing doxazosin and tamsulosin. Here is one study that compared doxazosin vs doxazosin GITS and also compared both to tamsulosin and alfuzosin from other studies. User reviews on drugs.com also favor doxazosin. However, there are less reviews of doxazosin.

The clinical efficacy and tolerability of doxazosin standard and gastrointestinal therapeutic system for benign prostatic hyperplasia - Fitzpatrick - 2005 - BJU International - Wiley Online Library
Doxazosin User Reviews for Benign Prostatic Hyperplasia at Drugs.com
Tamsulosin User Reviews for Benign Prostatic Hyperplasia at Drugs.com

Here is the first part of the conclusions from this study:

"Because it is generally the bothersome
symptoms that precipitate a patient’s desire
for treatment, the management of BPH
focuses on the relief of LUTS. Doxazosin is
effective in both normotensive and
hypertensive patients with BPH. Doxazosin
standard and GITS provide greater symptom
relief of LUTS caused by BPH than do
other agents, and are associated with
improvements in sexual function."

This is the first that I have heard of doxazosin GITS and I don't see it on my Medicare insurance formulary. I have always taken the standard doxazosin. Now that I'm on Medicare I don't have insurance coverage for Viagra, Cialis, etc. The government doesn't find it necessary for men over the age of 65 to have sex. Fortunately, I don't need either yet. It's too bad that Cialis isn't allowed for BPH.

From various published studies, it seems that both doxazosin and tamsulosin have their disadvantages. Apparently it takes tamsulosin 4 to 8 weeks to start working and it can't be stopped suddenly. It is also more of a problem for people who need cataract surgery.

http://www.ascrs.org/sites/default/...Advisory revision_JH_3 FINAL_FL DC edited.pdf

I had cataract surgery while on doxazosin and had no problems.

 

[Aces]

Does Doxazosin make you feel weak or tired in any way?
I know flomax is supposedly prostate specific and Doxazosin is more systemic and can relax muscles throughout your body causing muscles to look flat and feel tired/ weak.

 

[Pauly_P]

Thank you for that post TOF. I'm new here, but have suffered from BPF for 5+ years, in my early 60's. Tried Cialis, with the only improvement being in stream strength increase. Urgency was still there.

If the OP tries doxazosin I would like to hear back. I was on flomax for a bit, and it completely dried up my ejaculate. I would literally have dry orgasms. I got off that stuff.

 

[TheOldFart]

I've been taking the max BPH dose of doxazosin for so long that I am not completely sure of everything, but I don't remember any change at all after starting it except for BPH symptoms. I think I started taking it about 15 years ago. It didn't change the amount of ejaculate, as my wife can attest to. The amount has greatly reduced in the past year or so, but I'm 72 YO now and it's been so long since I started doxazosin that I can't blame it on that. My BPH has gotten slightly worse in the past 15 years, but still very manageable. I remember that I forgot to take it for 2 days while on a short trip a few years ago and I was peeing every 30-60 minutes the second day. It works very well for me.

I don't know why Flomax is more prescribed than doxazosin. Perhaps it is because it is a much newer drug, so there is belief that it must be better.

I find it confusing that it is Flomax that can cause cataract surgery problems and not doxazosin, as Flomax is the one that is prostate specific.

 

[Aces]

Pauly_P
Did your dry ejaculation start within a day or 2 of using flomax?
It just doesnt do that to me. It may reduce the amount slightly but thats it.
The newest is called Rapaflo and that works real well. However, that is known for dry ejaculation. The ejaculation flows backwards rather than forward. If you closed your eyes, the feeling is still the same.

Oldfart
So you expwrience no muscle weakness?
You can still get cataract surgery with flomax, you just need to tell the surgeon you are using it and you would be fine.

 

[TheOldFart]

I don't remember any change in strength when I started doxazosin. I'm not a weight lifter, but I bicycled back then and never noticed any loss of strength in hill climbs. Since I'm not a weight lifter, except light lifting, it might have been a bit difficult to recognize a small loss of strength.

I did see a loss of strength, among other things like ED, a few years after starting doxazosin and that was when I was diagnosed with low T.

 

[JC456]

Cialis and Finasteride/dutrasteride.

 

[TheOldFart]

If a person is not concerned about the possible sexual side effects of finasteride, a combination of doxazosin and finasteride is about twice as effective over the long term than either one alone. Since both are generic, use is much less expensive than combining one with Cialis.

MMS: Error

 

[Pauly_P]

Aces, the dry ejaculation started after about a month on Flomax. I was on it for about three months after an infection due to a prostrate biopsy. My BPH symptoms have continued to get worse really the last 5-7 years. That was my second negative biopsy. My PSA continues to be in the 3.7 range, but it had shot up to near 10, for whatever reason during that time. My T levels recently were 210, so I have been carefully starting TRT. Monitoring hormone levels and PSA/Free PSA. I have a lot to learn yet. Unfortunately I have no baseline T level, even though I've been a fanatic about annual physicals for decades due to my hobby requiring them. The medical profession needs to get their shit together.

Old Fart, thanks much for your great information. The next time I go for an injection I'll ask about doxazosin. I'm an avid weight lifter, and I certainly don't want to lose the gains I've made.