The effectiveness and safety of tamsulosin and terazosin for patients with benign prostatic hyperplasia (BPH) was evaluated by literature review. PubMed, Embase, the Cochrane Library, Chinese biomedicine literature database (CBM), reference lists of reports, and reviews were searched for randomized controlled trials (RCTs), or quasi-RCTs of tamsulosin versus terazosin in BPH. Twelve studies involving 2,816 men were included. Outcomes included international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Q_max), average urinary flow rate (Q_ave), residual volume, prostate volume, and adverse effect (dizziness, severe hypotension, dry mouth). Relative risk was calculated for dichotomous data. Sensitivity analyses assessed the influence of baseline symptom severity. We found that tamsulosin is better than terazosin when assessed by IPSS (weighted mean difference (WMD)=−1.24 95% CI [− 1.98, −0.51], there was no significant difference between the two groups in QOL (WMD=0.04 95% CI [−0.16, 0.24]), Qmax (WMD=−0.38 95% CI [−1.18, 0.41]), Q_ave (WMD=−0.39 95% CI [− 0.84, 0.06]), residual volume (WMD=−4.32 95% CI [−10.96, 2.33]), and prostate volume (WMD=−0.28 95% CI [− 3.37, 2.81]). Fewer patients receiving tamsulosin experienced dizziness (relative risk (RR) −0.38 95% CI [0.30, 0.48]), severe hypotension (RR=0.16 95% CI [0.04, 0.68]), and dry mouth (RR=0.14 95% CI [0.03, 0.77]), compared with patients receiving terazosin. Many of the high quality RCTs showed beneficial effects of tamsulosin in terms of improving IPSS. However, whether tamsulosin proves more efficacious than terazosin in long term therapy requires confirmation by additional large sample, high quality trials.