Finasteride (Proscar) vs Dutasteride (Avodart) for BPH

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Both Finasteride and Dutasteride reduce DHT and shrink the prostate, and improve BPH symptoms. However, both can have sexual side effects - reduction in sexual ability and desire. If these side effects are not an issue, why not choose either over some form of surgery?

Anyone on this forum have actual experience with either of these medications?

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  • Posted

    These are both nasty drugs. You have to take them for 6 months to see if they'll work and the incidence of sexual side effects is in the 25% range. And in some cases, they never reverse and men are impotent for life. There are fairly benign procedures that can solve the problem indefinitely without anesthesia and a low incidence of side effects. And they usually work. The drugs are side effect heavy and don't usually work. Your mileage may vary

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    • Posted

      Tom

      If sex is part of your concern stay away from both of these pill. They will slow down or stop your sex life. They will make the prostate smaller in time but the effects can stay for a long time or it can be permanent.

      Doctor give you these pills and others because they feel the benefits of the medicine out ways the side effect. They also do this with procedures. They do not look at the side effects of a procedure because they are trying to get you to pee better.

      If your doctor does not take your concerns at heart time to get another doctor.

      Good luck.........Ken

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    • Posted

      What did you have done for the prostate cancer that caused that? Something other than removal obviously. Yes - then there is less risk - but take note that an unexpected/explained side effect of Rezum is that has fired a significant number of men (close to 50%) up sexually. it might be worth trying because it will probably help your BPH and quite possible bring your sex function back.

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    • Posted

      oldbuzzard,

      Had radiation to the prostate for the cancer in 2014. Cancer gone (PSA 0.1 to 0.2) but so is sexual urge. If I had removed the prostate I wouldn't be having any BPH issues, but I might not be able to hold my urine and didn't want to wear diapers for the rest of my life.

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  • Posted

    My experience with these 2 drugs:

    Been on both for about 4 years.......urge for sex dropped off almost immediately.

    Although It could have been the pain and discomfort that started it.....here i am 5 years later, 3 weeks after Green Light surgery, haven't had any meds since then.

    Still have no urge or interest. Really hoping that passes......real soon.

    I think I will be very disappointed if it doesn't come around in the next few weeks.

    I had never heard of any long lasting side effects......certainly never heard of permanent effects......if so, then I'm gonna be p****d off.....

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  • Posted

    Yes, I was on finisteride and experienced lost of libido. i stopped it and returned to normal. i would not take it!!

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  • Posted

    Tom,

    I agree with the others on here that it is a very nasty drug. The side effects of low libido started slowly at first but I noticed a definite drop in desire. My doctors assured me that would pass. They lied. I have been taking it for 10 years and I have zero sex drive and cannot achieve erections. I am 54, so I was 44 when I started taking Jalyn (Dutasteride/Tamsulosin) and Rapaflo.

    I had UroLift surgery in December 2016. I am so angry at myself for trusting my Primary Care doctor and Urologist who both prescribed these drugs. If I stop taking them, I revert back to not being able to void my bladder without it being painful.

    My next step to see if anything can be done to help me regain my ability to have erections and reverse the effects of these prescription drugs will be seeing a specialist in another city.

    So I have learned a very hard lesson. My advice is do a lot of research before blindly trusting the professionals the way I did. I truly thought they had my best interest in mind and now realize that all the doctors care about is taking my money and pushing prescription drugs.

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  • Posted

    Tom: I've been meaning to post my experience with dutasteride/alfuzosin for some time now and your post spurred me to do this. I just posted it, if you are interested in reading it.

    If I recall correctly, your current PVR is 200 mL or more and your situation is pretty serious. Can you wait the several months it is going to take for the pills to reduce the size of your prostate? I also read somewhere that it wasn't clear that these pills can do much for a prostate with a large median lobe. How large is your prostate now? I don't mean to dissuade you, but from your previous blog posts it seems like you need to have relief fairly quickly. Also, if I recall correctly you had a PAE that was not very successful. If the PAE didn't help, I'm not sure why you think the dutasteride would help.

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    • Posted

      rdemyan,

      Yes, PVR is about 200ml. Prostate was 56gm before the PAE but has not been measured since. So, I am estimating about 40gm now, but PAE didn't address the issue, which was the median size, shape and how that is blocking the urine flow. So, at night it takes me multiple (usually 3-5) attemps to clear my bladder, and that can take 10-20 minutes. This happens about every hour and a half, so I never get a good night's sleep. So, if these meds won't do much for the median lobe issue, similar to the PAE problem, then I'm back to either a bipolar TURP or a second PAE. I am leaning toward the TURP because I need some relief now - not wanting to wait for months and months. Procedures like Rezum, or GL or anything that would cause the prostate to swell up would completely block my flow, so they are out. I am not going to go to the emergency room again in the middle of the night in horrible pain because I can't pee. I just tried to self cath but failed - too much pain. I feel like I am being backed into a corner and must move forward with my decision very soon.

      Tom

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    • Posted

      Tom:

      The literature that I have read states pretty much universally that dutasteride and finasteride work better with larger prostates than 40 grams. You'll see some reduction, but it won't be that much. Apparently trials have shown little help with symptoms in men who have "relatively" small prostates.

      TURP (bipolar or otherwise) causes swelling because heat is used. I'm not sure why you think TURP will result in a shorter catheter time than the other procedures. I too fear catherization, esp. from something as big as a Foley catheter. If I need a procedure, I plan to spend at least a week in a hotel near the center, in case problems come up and I need to be catherized or something else. I've never self catheterized in an emergency situation (even though I learned it for this purpose). A PA told me that if I can't do it successfully fairly quickly to get to an emergency room.

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    • Posted

      Both drugs will shrink your prostate, but just like PAE, there is no control where the shrinkage will occur, therefore may or may not help. However, if you're not concerned with possible sexual side effects, I'd give it a try. For some people, it can help after few weeks even though it usually takes up to 6 months to get to the maximum benefits.

      In light of your self cathing problem, I'd go for the bipolar Turp soon.

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    • Posted

      rdemyan,

      From the detailed reports on this forum after a bipolar TURP there is a Foley catheter for a few days. I don't have an issue with that because I had six of them in and out for five weeks after radiation for prostate cancer five years ago. I got used to the Foley quickly and actually liked it - always kept my bladder empty, and was able to sleep well with it - only got up once per night to empty the leg bag.

      Prostate swelling without a Foley leading to total retention can be a very serious issue. I had that happen to me post my second radiation treatment, and it was horrible - intense pain, a trip to emergency, then the nurse drained off 1200cc with a Foley, then all pain gone. That was when I had the six Foleys in and out until the swelling went down five weeks later. The pain from the retention was similar to when I had kidney stones many years before- about as intense as I could stand.

      Tom

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    • Posted

      "about as intense as I could stand."

      I think I understand. I had a very nasty UTI a few months ago. Awoke around 2 PM and sufferred with three hours of peeing around 10 to 20 mL about every 5 to 10 minutes. Incredibably painful bladder spasms. It was like a piston in my abdomen bearing down on both the bladder and rectum area. For about 1 hour whenever I would release my pelvic floor to pee during one of these spasm, there was also uncontrollable defecation. I soiled two pair of pants; one while trying to drive to the hospital. Gave up and went back home and toughed it out. Fortunately no organ damage. Learned to self-cath the next day because I never want to go through that again. Told my wife that I now understood the pain of childbirth. She scoffed of course 😃

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    • Posted

      Tom: I should add that after that UTI incident, I started checking my urine on a daily basis for UTIs using a urine dipstick. Only takes a minute or two. Since you have fairly high retention, it might not be a bad idea to get some of these strips. The ones I like can be purchased off of eBay. The strips are Siemens Multistix 10 SG. One hundred strips for about 20 bucks.

      I don't mean to be an alarmist, but with your retention and difficulty with self cathing, a UTI might result in complete AUR and necessitate a trip to the ER. The dipsticks won't prevent the UTI, but they should give you a jump start on treating it with antibiotics and being vigilant for possible AUR.

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    • Posted

      rdemyan,

      Have been tested several times in the past six months for UTIs and nothing showed up. However, that didn't mean no bacteria in my urine. So, I began adding powdered vitamin C to my daily blender drinks and that really helped to calm my bladder. Then, a few days ago, I began adding d-mannose powder as well. I had never heard of d-mannose until I looked up home cures for UTIs. It is the sugar from cranberries. Normally, people take the capsules that contain d-mannose plus cranberries and on Amazon these get 90% positive reviews. Anyway, after just a couple of days my bladder feels better and last night I slept for three hours in one stretch - a minor miracle for me. So, I believe there is a small amount of bacteria that can linger in the urine that is being retained in the bladder that doesn't show up in a normal urine test but does act as a bladder irritant, and using my vitamin C and d-mannose formula can be dealt with.

      You mentioned test strips. Do they show low levels of bacteria?

      Tom

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    • Posted

      Yes, I take D-Mannose and Cranberry pills every day as well.

      The strips measure 10 parameters, the results of which are compared to a color panel for each parameter. IIRC, the parameters that measure bacterial level are LEU (leukocytes) and NIT (nitrites). I like the Siemens because it's a big, well established company that generally makes hiqh quality products. IIRC, e-Coli will show up on the LEU results. If the LEU strip is a light tan after 60 seconds in contact with urine, then you are okay. If the strip is purplish this indicates leukocytes in the urine. A high number of leukocytes in the urine may indicate the presence of a urinary tract infection. One of the ten parameters also measures blood in the urine (even if it is not visible to the naked eye). Glucose, bilirubin, specific gravity, etc are also measured. You can probably google Siemens Multistix 10 SG for more info. I highly recommend them.

      I also have strips made by Roche, which is a large pharmaceutical company. There was a youtube video of a nurse at a hospital discussing the Roche urine strips. Same idea and parameters as the Siemens brand. I use the Roche brand as a backup and will use them to confirm "positive" results shown by the Siemens. Sometimes, I have trace blood in my urine as detected by the Siemens strips. The Roche strips have confirmed this result every time. These Roche strips can also be purchased on eBay for around $60. They are a bit harder to read, but might actually be of higher quality than the Siemens. But the Siemens should work just fine. I'm just in an "overkill" phase because I still have vivid memories of that nasty UTI.

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    • Posted

      Tom: That's great that you are seeing some results from taking the D-Mannose. Hopefully it persists.

      I too am a strong believer that bacteria in the bladder are often a cause of some urination issues. I've read that when a UTI is diagnosed increasing both fluid intake and D-Mannose can help to flush the bacteria out (but I would still get antibiotics). The higher the PVR, the more likely bacteria will grow because the urine has a higher residence time in the bladder (i.e there is less frequent "turnover" of urine in the bladder allowing for bacteria growth).

      I think you absolutely should get the Siemens strips. If the strips show high leukocytes you could immediately increase your D-Mannose intake until you can get to a doctor to have the UTI confirmed and antibiotics prescribed. It would be great if you find out that your current urination difficulties are mostly caused by bacteria, which you can manage. You'll still have prostate issues, but perhaps this will give you more time to make a decision on what to do.

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    • Posted

      rdemyan,

      I was studying the various strips available on Amazon, and went to the Siemens and Roche websites. Roche makes a big deal about vitamin C interfering with test results. Well, not only do I take a multi vitamin, but have been taking powdered vitamin C to help reduce the bacteria in my urine, and it has really worked well. So, I wasn't imagining things when I thought it was helping. So, it's possible that I did have a UTI previously, but it was not noticed due to my intake of vitamin C. I will have to figure out how to get the Roche chemstrips. On Amazon it says I have to have a business license to purchase. I am also wondering if I buy anything else the results might be "off" due to the vitamin C.

      Tom

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