Dear Dr. Roach: I have benign prostatic hyperplasia (BPH), and I am taking tamsulosin daily. It works and helps with my daily urination. How long should I continue to take it? Are there any related side effects? Or should I consider an eventual prostatectomy? Thank you. — A.

Answer: Tamsulosin is an effective treatment for most men with symptoms of an enlarged prostate. (BPH signifies noncancerous growth of the prostate gland.) It works by relaxing special muscle fibers in the prostate (“smooth muscle”), which allows the urethra — the tube that carries urine from the bladder outside of the body, going straight through the prostate — to drain the bladder faster and with less pressure.

The most common side effect of tamsulosin and similar medicines (called “alpha blockers”) is lightheadedness, especially upon standing. Newer medicines like tamsulosin and alfuzosin are less likely to have this side effects compared to older medicines like doxazosin, but it can be a problem, especially when first using it.

I tell my patients to first sit up on the bed, make sure that you are OK, stand up, make sure that you’re OK again, then walk to the bathroom. Headaches, runny or stuffy nose, and ejaculation problems are other possible side effects. If you haven’t developed these within a few weeks, you aren’t likely to.

Before having cataract surgery, any person who has ever taken an alpha blocker should tell their eye surgeon. Tamsulosin is particularly likely to cause a problem called “intraoperative floppy iris syndrome,” so the surgeon needs to be prepared just in case.

For my patients who are getting a good result with this class of medicine, I don’t recommend changing it unless it stops working or they develop side effects. Before considering prostate surgery or another prostate procedure, such as laser, steam, freezing or embolization, I often recommend a second class of medicines, the 5-alpha reductase inhibitors finasteride or dutasteride. These take longer to work but have a benefit of reducing prostate cancer risk by about 60%.

Most men have a good outcome with traditional prostate surgery or one of the newer, less-invasive techniques. However, I have had a few of my own patients and many readers tell me that their symptoms worsened after this treatment. This is why I don’t recommend surgery unless the medicines aren’t working.