Current status of 5α-reductase inhibitors in the management of lower urinary tract symptoms and BPH
Open Access
- 3 December 2009
- journal article
- review article
- Published by Springer Science and Business Media LLC in World Journal of Urology
- Vol. 28 (1), 9-15
- https://doi.org/10.1007/s00345-009-0493-y
Abstract
Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS in terms of symptoms and urinary flow, but also to identify those patients at a risk of unfavorable disease progression and to optimize their management. This article reviews the current status of therapy with 5α-reductase inhibitors (5ARIs), namely fiasteride and dutasteride, for men with LUTS and BPH. Data from key randomized controlled trials (Oxford level 1b) on the use of 5ARIs are analyzed. The efficacy of 5ARIs either as monotherapy or in combination with α1-adrenoceptor antagonists in the management of LUTS and the impact of monotherapy and combined therapy on BPH progression are discussed. Further promises, including the withdrawal of the α-blocker from the combined medical treatment and the potential clinical implications from the use of 5ARIs for prostate cancer chemoprevention in patients receiving 5ARIs for symptomatic BPH are highlighted. Current evidence shows that 5ARIs are effective in treating LUTS and preventing disease progression and represent a recommended option in treatment guidelines for men who have moderate to severe LUTS and enlarged prostates.Keywords
This publication has 37 references indexed in Scilit:
- Finasteride in the treatment of patients with benign prostatic hyperplasia: a reviewTherapeutics and Clinical Risk Management, 2009
- Use of 5α-Reductase Inhibitors for Prostate Cancer Chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice GuidelineJournal of Urology, 2009
- Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical managementInternational Journal of Clinical Practice, 2008
- DutasterideDrugs, 2008
- The Interpretation of Serum Prostate Specific Antigen in Men Receiving 5α-Reductase Inhibitors: A Review and Clinical RecommendationsJournal of Urology, 2006
- Dutasteride Improves Objective and Subjective Disease Measures in Men With Benign Prostatic Hyperplasia and Modest or Severe Prostate EnlargementJournal of Urology, 2006
- Combination Therapy With Doxazosin and Finasteride for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptoms and a Baseline Total Prostate Volume of 25 Ml or GreaterJournal of Urology, 2006
- Long‐term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5α‐reductase inhibitor dutasteride: results of 4‐year studiesBJU International, 2005
- Alpha-Blocker Therapy Can Be Withdrawn in the Majority of Men Following Initial Combination Therapy with the Dual 5α-Reductase Inhibitor DutasterideEuropean Urology, 2003
- Human prostatic steroid 5α-reductase isoforms—A comparative study of selective inhibitorsThe Journal of Steroid Biochemistry and Molecular Biology, 1995