4 smart tips for treating an enlarged prostate

Are you getting up to "go" more often — and spending more time starting or finishing the job? Does your bladder sometimes still feel full? Half of all men over age 50 eventually experience problems caused by an enlarged prostate, the gland that encircles the urethra, through which urine exits the bladder. Prostate enlargement, or benign prostatic hyperplasia (BPH), isn't a sign of prostate cancer, but symptoms can be similar, so see your doctor. Here are four treatments for BPH.

Finasteride (Proscar) and dutasteride (Duagen) work by reducing levels of dihydrotestosterone (DHT) — a potent form of testosterone that spurs the growth of prostate cells — by 80 to 90 percent.

• The result: over three to six months, your prostate deflates by about 20 percent.
• The drugs work best if you have urinary problems due to a moderately enlarged prostate gland; they're not very effective for men who have symptoms of BPH despite a normal size gland.
• Be patient; you may see some improvement in two or three months, but it could take a year for complete improvement.
• Side effects may include reduced libido and even impotence.

Your doctor may start with alpha-blocker drugs, such as tamsulosin (Flomax), which provide fast relief by relaxing the muscles around the neck of the bladder, opening the gates for better urination.

• Side effects include dizziness and sudden low blood pressure when you stand up (these tend to clear up quickly once your body gets used to the drug) and fatigue.
• You may also have problems with ejaculation, but studies show that taking some of these drugs every other day is just as effective for improving urination and reduces ejaculation problems.
• Be careful about taking an erectile dysfunction drug with these meds; the combination can cause dangerously low blood pressure.

If your symptoms don't improve with medications, or if you have ongoing complications like urinary tract infections, surgery may be your best option.

• Older procedures, from the most invasive (removal of the inner portion of the gland, called open prostatectomy) to transurethral resection of the prostate (TURP), ease symptoms by 88 to 98 percent.
• Long-term side effects may include retrograde ejaculation (in which semen flows into the bladder), impotence and incontinence, though these are uncommon.
• Newer, less invasive techniques that involve inserting a stent or use heat to shrink prostate tissue are almost as successful and have fewer side effects.

Small studies and lots of anecdotal evidence say the herb saw palmetto works as well as the drug finasteride.

• But a study of 225 men found it was no better than a placebo for shrinking the prostate or easing urinary problems.

Consider these tips to find a remedy that works and remember to always consult a doctor before starting any new medications.