The AUA recommends watchful waiting for patients with mild symptoms or without bothersome LUTS who have not developed a serious complication.

First Line

• α-adrenergic antagonists more effective than other methods alone (2)[A]:
  • Nonselective, reduce prostatic smooth muscle tone, improving urinary flow (3):
    • Terazosin (Hytrin): 1–10 mg/d PO (4)[A]
    • Doxazosin (Cardura): 1–8 mg/d PO
  • Selective, may produce fewer side effects. Generally more expensive:
    • Tamsulosin (Flomax): 0.4 mg/d PO (5)[A]
    • Alfuzosin (Uroxatral): 10 mg/d PO
• 5-α-reductase inhibitors reduce prostatic volume (useful if prostatic enlargement) (6)[A]:
  • Finasteride (Proscar): 5 mg/d PO
  • Dutasteride (Avodart): 0.5 mg/d PO
  • Also useful in controlling prostatic bleeding
• Combination therapy of α-blocker plus 5-α-reductase inhibitor is superior to monotherapy when used for very large prostates and evaluated over at least 4.5 years (7):
  • Dutasteride and tamsulosin combination known as Jalyn
• Contraindications:
  • α-blockers can cause orthostatic hypotension; less risk with tamsulosin and alfuzosin
  • See specific recommendations for α-blocker use with phosphodiesterase type-5 inhibitors (for erectile dysfunction).

ALERT
5-α-reductase inhibitors reduce PSA by 1/2, so the PSA result should be doubled for purposes of screening for prostate cancer.