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Urology · London

Medications for BPH, chosen properly.

Alpha-blockers, 5-alpha-reductase inhibitors, combination therapy, mirabegron and tadalafil - prescribed by a consultant urologist against your actual IPSS, PSA and prostate size, aligned with NICE NG97.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private BPH consultation and prescription cost in London.

NHS-funded when your GP prescribes. Privately, the consultation is where the value sits - the drugs themselves are cheap.

In short

A consultant urologist BPH assessment and first prescription: £250–£500, drug from £15/month.

Item Indicative range
Consultant urologist assessment (IPSS, DRE, flow, PVR) £250–£500
PSA blood test £60–£120
Alpha-blocker (tamsulosin) - monthly private script £15–£30
5-alpha-reductase inhibitor (finasteride / dutasteride) - monthly £20–£40
Combodart (tamsulosin + dutasteride) - monthly £30–£55
Mirabegron / solifenacin (OAB add-on) - monthly £25–£45
Tadalafil 5mg daily (BPH + ED) - monthly £30–£60
Review appointment (4–6 wk, then annual) £180–£350

Prices vary by clinic and by the urologist. On the NHS these medications are prescribed free at the point of use - private prescriptions cost £15–£60 per month per drug, plus the pharmacy fee.

The problem

The right drug for the right prostate - not tamsulosin for everyone.

BPH medication is often prescribed reflexively - tamsulosin for anyone with LUTS, without measuring prostate size, checking PSA properly, or asking about the OAB or ED components. NICE NG97 is clearer than that.

  • Prostate not measured?

    A 5-ARI belongs in a prostate over 30–40mL. Without a size, you cannot make that call.

  • OAB component missed?

    Persistent urgency after an alpha-blocker often needs mirabegron or a careful antimuscarinic - not more of the same drug.

  • ED never asked about?

    Tadalafil 5mg daily treats BPH and erectile dysfunction together - a sensible dual choice most GPs never mention.

When it helps

When BPH medication is the right step.

The scenarios where a proper medical review changes the drug, plus the red flag that means A&E rather than a prescription.

  • IPSS score >7 (bothersome LUTS)

    Weak stream, hesitancy, frequency, urgency, nocturia - the International Prostate Symptom Score is where every proper BPH consultation starts.

  • Prostate volume >30–40mL

    A larger gland on DRE or ultrasound is where a 5-alpha-reductase inhibitor earns its place alongside an alpha-blocker.

  • Overactive bladder component

    Urgency, urge incontinence and daytime frequency that persist after an alpha-blocker - mirabegron or an antimuscarinic added carefully.

  • BPH plus erectile dysfunction

    Tadalafil 5mg daily treats both - a sensible dual-purpose choice in the right man.

  • Failed self-care

    Fluid timing, caffeine and alcohol reduction, bladder training tried - symptoms still bothersome. Time to consider medication.

  • Prevent progression, avoid surgery

    5-ARIs reduce prostate volume 20–25% over 6–12 months and lower the long-term risk of retention and surgery (MTOPS, CombAT trials).

  • Baseline PSA + cancer exclusion

    Every BPH assessment starts with a baseline PSA and DRE to rule out prostate cancer masquerading as benign symptoms.

  • Red flag: acute urinary retention

    Painful inability to pass urine, haematuria with clots, or a rising creatinine on upper-tract imaging is not a medication problem - it is A&E, then surgery.

Drug classes

The medications, and what each one is really for.

Six classes matter in modern UK BPH care. Each one has a job - and a side-effect profile you should know before starting.

  • Alpha-blockers (tamsulosin, alfuzosin, doxazosin, silodosin)

    First-line. Relax smooth muscle at the bladder neck and prostate. Symptom improvement within 1–2 weeks. Retrograde ejaculation and orthostatic hypotension are the practical trade-offs.

  • 5-alpha-reductase inhibitors (finasteride, dutasteride)

    For a prostate over 30–40mL. Shrink the gland 20–25% over 6–12 months. Slow disease progression. Sexual side effects and halved PSA are the honest costs.

  • Combination therapy (Combodart, or separate agents)

    Alpha-blocker plus 5-ARI for larger prostates and moderate-severe symptoms. MTOPS and CombAT trials support the combined approach for long-term progression.

  • Antimuscarinics (solifenacin, tolterodine, oxybutynin)

    For a persistent overactive bladder component after an alpha-blocker. Careful in severe BPH - retention risk exists and must be monitored.

  • Beta-3 agonist (mirabegron)

    For overactive bladder symptoms. Better tolerated than antimuscarinics in older men, but blood pressure needs watching.

  • PDE5 inhibitor (tadalafil 5mg daily, Cialis)

    Dual benefit for BPH and erectile dysfunction. Increasingly used in the UK where both problems co-exist - not first-line for LUTS alone.

  • Watchful waiting and self-care

    Fluid timing, caffeine and alcohol reduction, bladder training, double voiding. For mild, non-bothersome symptoms - a legitimate first step, not a fob-off.

  • Herbal (saw palmetto, Serenoa repens)

    Mixed evidence; not endorsed by NICE. Sometimes tried but not a substitute for proper assessment and treatment.

Safety and side effects

What to expect once you start - honestly.

BPH medications are broadly well tolerated, but every class has a signature side effect. The right conversation before starting is worth more than a leaflet.

  • Alpha-blockers: first-dose hypotension

    Older agents like doxazosin can cause a first-dose faint - taken at bedtime, and the newer selective agents (tamsulosin, silodosin) are safer.

  • Retrograde ejaculation is common

    Silodosin > tamsulosin > alfuzosin for this. Semen goes into the bladder rather than out - harmless but worth knowing about before you start.

  • IFIS - tell your cataract surgeon

    Intraoperative floppy iris syndrome affects alpha-blocker users during cataract surgery. Always tell the eye surgeon you are on one, even if you stopped it years ago.

  • 5-ARIs halve your PSA

    After six months on finasteride or dutasteride, double the PSA result to compare like-for-like. Any rise on treatment needs urology review.

  • Sexual side effects on 5-ARIs

    Reduced libido, ED and ejaculation issues in a minority. Post-finasteride syndrome is debated but real to the men who experience it - worth discussing before you start.

  • Antimuscarinics: retention risk in severe BPH

    Dry mouth, constipation and blurred vision are common. In severe BPH they can tip you into retention - used cautiously and with PVR monitoring.

  • Mirabegron and blood pressure

    Blood pressure should be checked at baseline and after starting - occasional rises mean it is not for you.

  • Tadalafil headache and back pain

    Common in the first weeks, usually settles. Not to be combined with nitrates.

  • Red flags - stop and call

    Acute retention, blood in urine with clots, fever, or a sudden inability to pass water are not medication problems - same-day medical review, not the next appointment.

Reading your consultation note

Your consultation note in four parts. Read the last one first.

Whichever drug was chosen, the note the urologist sends you keeps to the same shape.

A UK consultant urologist reviewing a patient’s BPH medication plan

A quiet reminder

Medication names and reasoning can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    IPSS, PSA and prostate volume

    Your baseline International Prostate Symptom Score, PSA level, DRE findings and estimated or ultrasound-measured prostate volume - the numbers every future review compares against.

  2. 02 Technique

    Drug, dose and reasoning

    Which medication was chosen (alpha-blocker, 5-ARI, combination, antimuscarinic, mirabegron, tadalafil), the dose, and the reasoning - prostate size, ED, OAB component, side-effect profile.

  3. 03 Findings

    Flow rate, PVR and any red flags

    Peak flow rate (Qmax), post-void residual, and any red-flag findings - haematuria, retention episodes, hydronephrosis on imaging - that would change the plan.

  4. 04 Impression

    Review plan and when to escalate

    Read this first: when to review (4–6 weeks then annual), what to monitor (PSA, BP, IPSS, PVR), and when to consider surgery instead.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

The consultation is usually covered under outpatient benefits; ongoing private prescriptions are typically self-pay.

Frequently asked

Everything we get asked about BPH medications.

Quick answers on first-line therapy, side effects, prostate shrinkage and when to consider surgery instead.

  • Which medication is first-line for BPH?

    An alpha-blocker such as tamsulosin - it works within 1–2 weeks by relaxing smooth muscle at the bladder neck and prostate. If the prostate is over 30–40mL, a 5-alpha-reductase inhibitor (finasteride or dutasteride) is added to shrink the gland over time.

  • What are the side effects of tamsulosin?

    Retrograde ejaculation is common - semen goes into the bladder rather than out. Dizziness, orthostatic hypotension and nasal stuffiness can occur. It also causes intraoperative floppy iris syndrome, so always tell your cataract surgeon you are on one.

  • How long before finasteride starts working?

    Prostate volume drops 20–25% over 6–12 months, and symptom benefit usually shows around 3–6 months. It is a long game - worth it for larger prostates and progression prevention, not for quick symptom relief.

  • Do BPH medications shrink the prostate?

    Only the 5-alpha-reductase inhibitors (finasteride, dutasteride) actually shrink the gland - by around 20–25% over 6–12 months. Alpha-blockers relax muscle tone but do not change the size.

  • Can I take Cialis (tadalafil) for BPH?

    Yes - tadalafil 5mg daily is licensed for BPH and treats erectile dysfunction at the same time. A sensible dual-purpose choice for men with both problems. Not first-line for LUTS alone.

  • When do I need surgery instead of medication?

    When medical therapy fails to control symptoms, or if there is recurrent retention, bladder stones, recurrent UTI, or upper tract deterioration. Options include Rezum, iTIND, HoLEP, PVP laser and TURP - chosen by prostate size and your priorities.

  • Do 5-ARIs affect my PSA test?

    Yes - finasteride and dutasteride roughly halve PSA after six months. Any interpretation of a PSA result needs to be doubled to compare with pre-treatment levels. A rise on treatment always needs urology review.

  • Can antimuscarinics cause urinary retention?

    In severe BPH, yes. Antimuscarinics like solifenacin are added carefully for men with a persistent overactive bladder component, with post-void residual monitored. Mirabegron is often preferred first for older men.

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