Best Treatments for an Enlarged Prostate (Review & Buying Guide)
We make one of the 5 options below. It's number one on this page — but not because it won anything. This list is ordered from least invasive to most invasive, and a non-prescription option necessarily comes first. Position here is not a ranking.
Each option gets a "best for" label describing the one thing it genuinely does better than the others. Ours is the narrowest label on the page, because that's an accurate description of where it fits.
This is general education, not medical advice. Nothing here is a reason to stop or change a medication your doctor prescribed. Talk to them first.
Most men get about 4 minutes on this topic at an annual physical. You hear "it's a little enlarged," you hear "we'll keep an eye on it," and that's the whole conversation. This is the longer version — 5 treatment options, what each one actually does to the problem, and what each one costs you beyond money.
- Every option is scored on the same six criteria: mechanism, speed, effect on prostate size, effect on disease progression, side effects, and cost.
- Pros and cons are written from published clinical evidence and prescribing information, not from marketing material — including for our own product.
- Where the evidence for a category is weak or mixed, we say so.
- Prescription options link to a doctor conversation, not to a purchase.
- Reviewed by a licensed clinician before publication.
- Prostate Longevity Protocol — best before medication, or alongside it
- Alpha-blockers (Flomax / tamsulosin) — best for fast relief
- Daily tadalafil 5 mg — best if you also have ED
- 5-ARIs (finasteride / dutasteride) — best for actually shrinking the prostate
- TURP surgery — best for severe symptoms and complications
1. Prostate Longevity Protocol
A two-part, non-prescription approach: a daily capsule formulated around saw palmetto, beta-sitosterol and pygeum, paired with an external therapy device for the pelvic floor.
The evidence base for this category is genuinely mixed. The largest and most rigorous saw palmetto trial found no benefit over placebo even at triple dose; trials using a standardised liposterolic extract have been more favourable.
- How it works
- Botanicals proposed to act on the DHT pathway; device targets pelvic floor tension
- Time to effect
- Days to 2 Weeks, gradual
- Shrinks prostate
- Not established
- Slows progression
- Not established
- Cost per year
- $109–$199
- Prescription
- No
- No prescription required
- No retrograde ejaculation or known sexual side effects
- Full per-ingredient amounts disclosed — no proprietary blend
- Standardised extract, not powdered berry
- Evidence base for the category is mixed and contested
- Effect is smaller than any prescription option on this page
- Not adequate on its own for moderate-to-severe symptoms
- Not covered by insurance — you pay the full price
30-day guarantee · Discreet packaging · Not a treatment for any disease
Where this honestly fits: if your symptoms are significantly disrupting your sleep or daily life, this rung alone is unlikely to be enough, and the right next step is a doctor — not a larger supplement order.
2. Alpha-Blockers — Tamsulosin (Flomax), Alfuzosin, Silodosin
Usually the first drug prescribed, and by a distance the fastest-acting option here. Most men notice a difference within days to two weeks.
Alpha-blockers relax the smooth muscle in the prostate and bladder neck so urine flows past the obstruction more easily. The prostate itself is unchanged.
- How it works
- Relaxes smooth muscle at the bladder neck
- Time to effect
- Days to 2 weeks
- Shrinks prostate
- No
- Slows progression
- No
- Cost per year
- Roughly $630–$1,360 at retail without insurance
- Prescription
- Yes
- Fastest relief of anything on this page
- Inexpensive as a generic
- Strong, well-documented effect on urinary flow
- Fully reversible
- Retrograde ejaculation is common
- Dizziness and blood pressure drops on standing
- Associated with floppy iris syndrome during cataract surgery
- Does nothing to the prostate itself
Prescription only. We don't sell this and have no affiliation.
Alpha-blockers are associated with intraoperative floppy iris syndrome, which complicates cataract surgery — and this applies even if you stopped taking the drug some time ago.
3. Daily Tadalafil 5 mg
Approved for BPH symptoms and badly under-discussed. It's the same molecule used for erectile dysfunction, taken at a lower dose every day rather than as needed.
- How it works
- Relaxes smooth muscle and improves blood flow in the prostate, bladder and pelvis
- Time to effect
- 2 - 4 weeks
- Shrinks prostate
- No
- Slows progression
- No
- Cost per year
- Roughly $620–$3,350 for the generic
- Prescription
- Yes
- Addresses urinary symptoms and erectile difficulty with one prescription
- No retrograde ejaculation
- Once daily, no timing required
- Fully reversible on stopping
- Cannot be taken with nitrates — absolute contraindication
- Smaller improvement in flow rate than alpha-blockers
- Headache, back pain, flushing, nasal congestion
- Often more expensive than generic tamsulosin
Prescription only. We don't sell this and have no affiliation.
If you take nitrates for chest pain — nitroglycerin, isosorbide — combining them with tadalafil can cause a dangerous drop in blood pressure.
4. 5-Alpha-Reductase Inhibitors — Finasteride, Dutasteride
This is the option that changes the prostate itself. These drugs block the enzyme that converts testosterone to DHT, the signal driving continued growth.
It's the only drug class here that slows the condition rather than managing its symptoms. The cost is time — three to six months before most men notice anything.
- How it works
- Blocks conversion of testosterone to DHT
- Time to effect
- 3 to 6 months
- Shrinks prostate
- Yes — commonly reported around 20–25%
- Slows progression
- Yes
- Cost per year
- Around $550 for finasteride; dutasteride closer to $2,000
- Prescription
- Yes
- Genuinely shrinks the prostate — the only drug here that does
- Reduces risk of urinary retention and future surgery
- Inexpensive as a generic
- Can be combined with an alpha-blocker
- Three to six months before you feel anything
- Sexual side effects in a minority
- Halves your PSA reading — affects cancer screening interpretation
- Not an option if you need relief quickly
Prescription only. We don't sell this and have no affiliation.
These drugs reduce PSA by roughly half within six to twelve months. Make sure whoever interprets your PSA knows you're taking one.
5. TURP Surgery
The most effective option here, and the one with the most permanent consequences.
The main trade-off is retrograde ejaculation, which occurs in the majority of men after TURP and is generally permanent. Ask about HoLEP and Aquablation as newer alternatives.
- How it works
- Surgically removes obstructing prostate tissue via the urethra
- Time to effect
- Immediate, after recovery
- Shrinks prostate
- Yes — tissue is removed
- Slows progression
- Yes — definitively
- Cost
- $7,500–$25,000 without insurance; far lower when covered
- Prescription
- Surgery — urologist referral
- Most effective option available
- Durable — low rates of needing anything further
- Relief is immediate once you've recovered
- The correct answer for severe obstruction
- Retrograde ejaculation in the majority of men, usually permanent
- Catheter and a recovery period
- Surgical and anaesthetic risk
- Not reversible
Procedure. We don't sell this and have no affiliation.
All 5 Compared
| Option | Speed | Shrinks prostate | Slows progression | Affects ejaculation | Reversible |
|---|---|---|---|---|---|
| Prostate Longevity Protocol | Weeks | Not established | Not established | No | Yes |
| Alpha-blockers | Days–2 weeks | No | No | Commonly | Yes |
| Tadalafil 5 mg | 2–4 weeks | No | No | No | Yes |
| 5-ARIs | 3–6 months | Yes | Yes | In a minority | Mostly |
| TURP surgery | Immediate | Yes | Yes | Usually, permanently | No |
Buying Guide: How to Choose
Urologists use a standard questionnaire called the IPSS — the International Prostate Symptom Score. It's free, takes two minutes, and you can fill it in before an appointment so the conversation starts from data instead of impressions.
- What's my IPSS score, and has it changed since last year?
- Do you know my prostate volume?
- Does what you're recommending shrink the prostate or manage the symptom?
- What are the sexual side effects, specifically?
- If I start this, what's the plan for reviewing it, and when?
- Are there minimally invasive options that would apply to me before surgery?
Seek medical attention promptly for: complete inability to urinate; blood in your urine; fever with pain or burning; repeated urinary tract infections; pain in your lower back or sides alongside urinary symptoms.
Our Recommendation
The gap it's actually built for is the one almost nobody addresses: you've been told your prostate is a little enlarged, you've been told they'll keep an eye on it, and you've been sent home with nothing to do. Your symptoms aren't severe enough that a doctor wants to prescribe, but they're bothering you enough that you're reading a thirteen-minute article about it.
There is a real space between “change your habits” and “take a drug that alters your hormone levels.” That space is where this sits. It works on the DHT pathway from the inside and the pelvic floor from the outside, which is the one thing on this page that nothing else attempts — and it does it without a prescription, without retrograde ejaculation, and reversibly.
- Your IPSS is mild-to-moderate and you've been left with no plan
- You'd rather not start a prescription yet, or want to do something while you decide
- The sexual side effects on this page are the thing making you hesitate
- You're already on medication and want to add something alongside it — with your doctor's agreement
- You want something you can stop at any time with nothing to undo
- Your symptoms are severe or your IPSS is above 20 — see a urologist
- You need relief this week — that's an alpha-blocker, not this
- You want the gland to actually shrink — that's a 5-ARI
- Erectile difficulty bothers you more than urination — ask about daily tadalafil
- Cost is the deciding factor — a discounted generic is cheaper than we are
- You have retention, blood, fever or repeat infections — see a doctor now
We're not going to tell you it shrinks your prostate, cures anything, or replaces what your doctor gave you. We don't know the first two, and the third isn't true. The evidence for this category is mixed, and we said so in section 1 rather than burying it.
What we will tell you is that “we'll keep an eye on it” isn't a plan, and that a man sitting in the gap above is currently offered almost nothing. That's the problem we built for.
30-day guarantee · Discreet packaging · Every amount printed, no proprietary blends
Frequently Asked Questions
Does an enlarged prostate turn into prostate cancer?＋
No. BPH and prostate cancer are separate conditions. They can coexist, and because both become more common with age many men have both — but one does not cause the other.
Can I take a supplement alongside my prescription?＋
Often yes, but ask your doctor or pharmacist first. What you should not do is stop a prescription in order to try a supplement instead.
Does saw palmetto actually work?＋
The honest answer is that the evidence is mixed. The largest, best-designed trial found no benefit over placebo. Some trials using a specific standardised extract found benefit.
How long before I should expect to notice anything?＋
Alpha-blockers: days to two weeks. Tadalafil: two to four weeks. 5-ARIs: three to six months. Supplements: weeks, gradually.
This is the part where we recommend our own product, so read it knowing that. Rather than tell you it's the best option on this page — it isn't, and the table above says so — here is the narrow set of circumstances where we think it's genuinely the right call, and the circumstances where it isn't.
The Bottom Line
There's no single best treatment here — there's a ladder, and the right rung depends on how severe your symptoms are, how much they bother you, how fast you need relief, and which trade-offs you'll accept.
Take the IPSS, write down which of these you want to ask about, and have the conversation.
Disclosure. This page is published by Prostate Treatment Guide Inc, which manufactures and sells the product described in section 1. We have a direct financial interest in that product.
Not medical advice. General educational information only. Do not start, stop or change any prescribed medication based on this page.
Supplement statement. Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure or prevent any disease.
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