Enlarged prostate (BPH)
What to consider when tamsulosin, finasteride or combination therapy no longer controls urinary symptoms, and how prostate artery embolization compares.
Editorially updated October 5, 2026. This educational article was prepared by SoCal Interventional using the cited primary and authoritative sources. It does not replace an individualized medical evaluation.
Quick answer: BPH medication helps many men, but it can lose effect as the prostate keeps growing, or cause side effects such as dizziness, ejaculation changes or reduced sexual desire. In the PARTEM randomized trial, men with prostates of 50 mL or larger whose symptoms persisted on an alpha blocker improved more after prostate artery embolization (PAE) than after combined tamsulosin plus dutasteride (IPSS change −10.0 vs −5.7 at 9 months), with better sexual-function scores. PAE is not a replacement for every medication, and candidacy depends on diagnosis, prostate size and anatomy.
Prostate artery embolization is offered at our Fountain Valley office in Orange County as well as in Los Angeles and Tarzana. Call (310) 929-0026 or request an evaluation.
BPH medications either relax the muscle in the prostate and bladder neck (alpha blockers such as tamsulosin) or slowly shrink the gland (5-alpha reductase inhibitors such as finasteride). They stop working mainly because the prostate keeps growing: a relaxed muscle cannot overcome a steadily larger obstruction, and the shrinkage from a 5-ARI is partial and slow.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes three main medication types for benign prostatic hyperplasia. Alpha blockers such as tamsulosin relax the muscle in the bladder neck and prostate so urine flows more easily. 5-alpha reductase inhibitors (5-ARIs) such as finasteride and dutasteride help stop the growth of, or shrink, the prostate. Phosphodiesterase-5 inhibitors (tadalafil) relax the same muscles and can relieve some symptoms. NIDDK also notes that a combination of an alpha blocker and a 5-ARI may work better than either alone.
Alpha blockers do not shrink the prostate, so as the gland keeps enlarging the muscle-relaxing effect can be outpaced by the obstruction. 5-ARIs shrink the gland slowly: MedlinePlus notes it may take at least six months before symptoms improve with finasteride, and the reduction is partial. Some men also stop a medication because of its side effects rather than because it has stopped working.
The side effects that most often prompt men to ask about PAE are dizziness or fainting on standing, nasal congestion and ejaculation changes with tamsulosin, and lower sexual desire, ejaculation problems or erectile difficulty with finasteride. None is dangerous for most men, but living with them every day is a common reason to look at a one-time procedure.
MedlinePlus lists common tamsulosin effects including sleepiness, weakness, runny or stuffy nose, blurred vision and difficulty ejaculating, and advises getting out of bed slowly because of dizziness or fainting, especially when starting or increasing the dose. Men who take tamsulosin should also tell their eye surgeon before any eye surgery. For finasteride, MedlinePlus lists decreased sexual desire, ejaculation problems and difficulty having or keeping an erection, and notes that finasteride changes PSA test results, which matters for prostate cancer screening.
None of these effects is dangerous for most men, but they are a common reason patients ask whether a procedure could replace daily medication. That question is reasonable, and it starts with confirming that BPH, not another condition, is causing the symptoms.
The PARTEM trial (Sapoval and colleagues, The Lancet Regional Health – Europe, 2023) is the first randomized trial to compare PAE directly with combination medical therapy. Ninety men with prostates of 50 mL or larger and symptoms that persisted on an alpha blocker alone were randomized to PAE or to daily dutasteride 0.5 mg plus tamsulosin 0.4 mg. The table summarizes the published results.
| Outcome at 9 months (PARTEM) | PAE | Combined medication |
|---|---|---|
| Change in symptom score (IPSS) | −10.0 points | −5.7 points |
| Change in sexual-function score (IIEF-15) | +8.2 | −2.8 |
| Men with at least one adverse event | 31 of 44 | 21 of 43 |
| Went on to an invasive treatment by 24 months | 5 of 42 (12%) | 18 of 38 (47%) |
The between-group difference in IPSS was 4.4 points in favor of PAE (p = 0.0008), and no serious treatment-related adverse events were reported. The authors concluded that PAE provides more urinary and sexual-symptom benefit than combined therapy up to 24 months in this group. Two cautions apply: the trial was open-label and relatively small, and it enrolled men with larger prostates, so the results do not automatically extend to smaller glands or to men who have never tried medication.
Guidelines treat PAE as an option for selected men after medication, not a first step. The AUA guideline places lifestyle measures and medication first and considers procedures when symptoms stay uncontrolled or side effects are unacceptable; the Society of Interventional Radiology’s multisociety statement supports PAE for appropriately selected patients.
The American Urological Association BPH guideline frames medication as the usual first step after lifestyle measures, with shared decision-making about escalating treatment when symptoms are not controlled or side effects are unacceptable. NIDDK lists minimally invasive therapies and surgery as options when medication does not work well enough, symptoms significantly affect quality of life, or complications develop. The Society of Interventional Radiology’s multisociety position statement supports PAE as an option for appropriately selected men, and our PAE vs UroLift, Rezūm, Aquablation and TURP comparison describes how PAE differs from the other procedures those guidelines cover.
It may be time for a PAE evaluation when symptoms return after improving on medication, when a second drug or a higher dose adds little, when side effects affect sleep or intimacy, when imaging shows a large prostate that is still growing, or after urinary retention or repeated infections. The evaluation confirms the cause before any procedure is recommended.
Common reasons men ask about PAE after medication include: symptoms returning after an initial improvement; needing a second drug, or a higher dose, with diminishing benefit; side effects that interfere with daily life, sleep or intimacy; a prostate that imaging shows is large and still growing; and episodes of urinary retention or recurrent infections. None of these proves that PAE is the right next step. Our PAE candidacy page lists the tests usually reviewed, including PSA history, prostate imaging and urinary testing, and the situations in which another treatment is more appropriate.
PAE does not remove the prostate, does not treat prostate cancer, and does not guarantee that medication can be stopped. Improvement is usually gradual over weeks to months, some men improve only partly, and some later need medication again, repeat embolization or a different procedure. A sham-controlled trial design has not been used in the PAE-versus-medication comparison, which is one reason the evidence is still described as evolving. The right decision weighs the probable benefit against these limits for each patient.
No. Keep taking prescribed medication unless the prescribing clinician says otherwise. The evaluation reviews how well the medication is working, what side effects it causes, prostate size, and whether PAE or another option fits.
Yes. In the PARTEM trial, men were enrolled after alpha-blocker therapy had not controlled symptoms, and many had already tried medication for years. Whether to continue, taper or stop medication after PAE is decided case by case.
Alpha blockers act within days; 5-alpha reductase inhibitors take about six months. PAE improvement is gradual over weeks to months, and the degree of improvement varies.
Most PAE trial evidence, including PARTEM, enrolled men with prostates of 50 mL or larger. Smaller glands are evaluated individually, and another option may be more appropriate.
Coverage depends on the plan, medical necessity, provider participation and authorization. Benefits should be verified before any procedure is scheduled; see our PAE cost and insurance page.
Call (310) 929-0026 or request a consultation. Orange County patients are seen at our Fountain Valley office, 10900 Warner Avenue, Suite 101A, Fountain Valley, CA 92708; Los Angeles patients are seen in Van Nuys and Tarzana. Bring your current medication list, any prostate imaging and PSA results.
Medical disclaimer: This article provides general education and cannot determine individual candidacy or outcome. Do not stop or change prescribed medication without talking to the prescribing clinician.
Explore more: Read the complete prostate artery embolization treatment guide, our PAE cost and insurance page, the PAE Patient Resource Center, and our Medical Editorial Policy.
Medical content reviewed by Nathanael Sabbah, MD, interventional radiologist. Last reviewed: October 2026.