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A man’s prostate becomes larger as he ages, a condition known as benign prostatic hypertrophy, or BPH.  It’s usually not a serious or life-threatening condition, but it can cause problems with urinating, primarily in men age 50 and older. 

Many men with BPH will either have no symptoms or symptoms that are mild and not that bothersome. But for millions of others, the urinary problems caused by BPH can be burdensome and interfere with their quality of life. Some men with BPH, for example, feel the urge to get up several times throughout the night to urinate, which can interrupt their sleep and leaves them tired and groggy the next day.  Concerns about urinary problems can also lead some men with this condition to give up routine activities such as sports or going to the movies when it may be difficult to find or reach a restroom.

You should see a doctor if you have urinary problems.  The symptoms of BPH can be similar to the symptoms of prostate cancer, so it’s important to get an accurate diagnosis. You should also contact your doctor immediately if you have a fever or chills, pain in your back, side or abdomen, cloudy or bloody urine, or pain when urinating. Those could be signs of serious complications that require medical attention.

If you have urinary problems due to BPH, lifestyle changes can often provide relief and should be tried first.  Those include going to the bathroom when you first feel the urge, reducing or eliminating your intake of alcohol and caffeine, and limiting your fluid intake before bedtime.

If your symptoms persist or worsen, the next step is usually to consider medication.  Two classes of drugs are commonly used to treat prostate enlargement: alpha-blockers and 5-alpha-reductase inhibitors.  Alpha-blockers are generally used first because they act fast, relieving urination problems in a matter of days or weeks, while reductase inhibitors can take several months to provide relief.  Sometimes the two types of drugs are used in combination.

Taking the evidence for effectiveness, safety, cost, and other factors into account, if you and your doctor decide that a drug is appropriate to treat your symptoms of an enlarged prostate, we have chosen the following alpha-blocker as a Consumer Reports Best Buy Drug:

 doxazosin

It's a good first option. We picked it as our Best Buy because it has a long track record of being both safe and effective. It's also available as an inexpensive generic drug, costing $12 or less for a month's supply. The savings would be significant vs. taking one of the costly brand-name alpha-blockers, which can run more than $100 per month.

If doxazosin doesn’t work for you, you might try another alpha-blocker, terazosin. Or you and your doctor might want to consider adding a reductase inhibitor to your regimen. In that case, we recommend finasteride. It is the only reductase inhibitor available as a generic, so it costs significantly less than a brand-name drug. In addition, the combination of finasteride and doxazosin has been proven to delay the progression of BPH symptoms.

Generic tamsulosin, which was approved by the FDA in March 2010, may be an option to consider if you don't respond well to doxazosin or terazosin. However, tamsulosin is only available in one dosage strength, so if you need to increase your dose, you will have to pay double.

This report was last updated in March 2010.