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Drugs to Treat Enlarged Prostate: Summary of Recommendations

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, caffeine, antihistamines, and decongestants, 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 $8 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.

This report was last update in May 2012.

Drugs to Treat Enlarged Prostate
Note: If the price box contains a , that indicates the dose of that drug is likely available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam's Club, Target, and Walmart offer a month's supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Recommendations: Drugs to Treat Enlarged Prostate
CR Best Buy Generic Name and Dose Brand name1 Number of pills per day2 Average monthly cost3 Compare Prices
Alpha-Blockers
Alfuzosin 10 mg sustained-release tablet Generic One $82
Alfuzosin 10 mg sustained-release tablet Uroxatral One $161
best buy Doxazosin 1 mg tablet Generic One $8
Doxazosin 1 mg tablet Cardura One $74
best buy Doxazosin 2 mg tablet Generic One $8
Doxazosin 2 mg tablet Cardura One $75
best buy Doxazosin 4 mg tablet Generic One $7
Doxazosin 4 mg tablet Cardura One $74
best buy Doxazosin 8 mg tablet Generic One $7
Doxazosin 8 mg tablet Cardura One $73
Doxazosin 4 mg sustained-release tablet Cardura XL One $81
Doxazosin 8 mg sustained-release tablet Cardura XL One $86
Prazosin 1 mg capsule Generic Two $14
Prazosin 2 mg capsule Generic Two $16
Prazosin 5 mg capsule Generic Two $20
Silodosin 4 mg capsule Rapaflo One $163
Silodosin 8 mg capsule Rapaflo One $159
Tamsulosin continuous-delivery capsule 0.4 mg Generic One $78
Tamsulosin continuous-delivery capsule 0.4 mg Flomax One $183
Terazosin 1 mg capsule Generic One $26
Terazosin 2 mg capsule Generic One $24
Terazosin 5 mg capsule Generic One $24
Terazosin 10 mg capsule Generic One $29
5-alpha-reductase inhibitors
Dutasteride 0.5 mg capsule Avodart One $146
Finasteride 5 mg tablet Generic One $75
Finasteride 5 mg tablet Proscar One $134
1. 'Generic' indicates that it's the generic version of the drug.

2. As typically prescribed.

3. Prices reflect nationwide retail average for March 2012, rounded to the nearest dollar if you were to pay the cash price. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations. We omit drugs with a low number of prescriptions (less than 20) because the prices are unreliable and these medications might be difficult to find because pharmacies often won't stock drugs if there is little or no demand for them.