We always hear that tamsulosin is the go-to for BPH, but I’m confused about where alfuzosin and especially prazosin fit in. If prazosin is also an alpha-1 blocker, why is it basically never used for BPH unless the patient also has hypertension? Aren’t they all doing the same thing? And honestly, is this whole idea of ‘prostate selectivity’ real, or is it just a marketing story?
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are among the most common issues you will encounter in older men. Two of the most frequently prescribed drugs for BPH, alfuzosin and tamsulosin, belong to the same class of α₁ (alpha-1)-adrenergic blockers but differ in receptor selectivity, side-effect profile, and clinical nuances. Another α₁-blocker, prazosin, sometimes enters the discussion but is used far more often for refractory chronic hypertension and PTSD-related nightmares than for BPH.