5 α -reductase inhibitors: what role should they play?

5 α -reductase inhibitors: what role should they play? The development of finasteride (PROSCAR, Merck & Co., Whitehouse Station, NJ) for the treatment of benign prostatic hyperplasia (BPH) has had variable results. Numerous short-term and long-term studies comparing finasteride with placebo have been reported. The results suggest that, physiologically, treatment with finasteride significantly decreases levels of both serum and intraprostatic dihydrotestosterone about 70% to 80% from baseline. In addition, total gland size decreases significantly—about 15% to 25% from baseline—particularly in the area of the periurethral zone of the prostate after finasteride treatment. Baseline prostate size has been found to have a relation to efficacy of finasteride treatment. The larger the prostate at baseline, the greater the urinary flow rate increase and symptom score decrease compared with placebo. Health-related quality-of-life parameters improved in those taking finasteride. In studies evaluating combination therapy, no significant differences were noted between those treated with an α blocker, such as terazosin or doxazosin in combination with finasteride, and those receiving an α blocker alone. Long-term finasteride versus placebo studies, such as the PROSCAR Long-Term Efficacy and Safety Study (PLESS), suggest that long-term medical therapy with finasteride affects the natural history of the disease as manifested by the decrease in rates of acute urinary retention and surgery. In patients who are “therapeutic responders,” the degree of symptomatic improvement in those treated with finasteride appears to be equal to that seen in patients receiving α blockers. Prostate cancer detection rates did not differ between those treated with finasteride and those receiving a placebo. The results of these studies suggest that physicians must evaluate what role finasteride plays in the spectrum of available options for the treatment of BPH and lower urinary tract symptoms. Baseline parameters, such as prostate volume, prostate-specific antigen values, and whether to administer finasteride in combination with α blockers, are among the factors that will determine the appropriateness of such therapy. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Urology Elsevier

5 α -reductase inhibitors: what role should they play?

Urology , Volume 58 (6) – Dec 1, 2001

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Publisher
Elsevier
Copyright
Copyright © 2001 Elsevier Science Inc.
ISSN
0090-4295
D.O.I.
10.1016/S0090-4295(01)01347-4
Publisher site
See Article on Publisher Site

Abstract

The development of finasteride (PROSCAR, Merck & Co., Whitehouse Station, NJ) for the treatment of benign prostatic hyperplasia (BPH) has had variable results. Numerous short-term and long-term studies comparing finasteride with placebo have been reported. The results suggest that, physiologically, treatment with finasteride significantly decreases levels of both serum and intraprostatic dihydrotestosterone about 70% to 80% from baseline. In addition, total gland size decreases significantly—about 15% to 25% from baseline—particularly in the area of the periurethral zone of the prostate after finasteride treatment. Baseline prostate size has been found to have a relation to efficacy of finasteride treatment. The larger the prostate at baseline, the greater the urinary flow rate increase and symptom score decrease compared with placebo. Health-related quality-of-life parameters improved in those taking finasteride. In studies evaluating combination therapy, no significant differences were noted between those treated with an α blocker, such as terazosin or doxazosin in combination with finasteride, and those receiving an α blocker alone. Long-term finasteride versus placebo studies, such as the PROSCAR Long-Term Efficacy and Safety Study (PLESS), suggest that long-term medical therapy with finasteride affects the natural history of the disease as manifested by the decrease in rates of acute urinary retention and surgery. In patients who are “therapeutic responders,” the degree of symptomatic improvement in those treated with finasteride appears to be equal to that seen in patients receiving α blockers. Prostate cancer detection rates did not differ between those treated with finasteride and those receiving a placebo. The results of these studies suggest that physicians must evaluate what role finasteride plays in the spectrum of available options for the treatment of BPH and lower urinary tract symptoms. Baseline parameters, such as prostate volume, prostate-specific antigen values, and whether to administer finasteride in combination with α blockers, are among the factors that will determine the appropriateness of such therapy.

Journal

UrologyElsevier

Published: Dec 1, 2001

References

  • Sex steroid receptors in normal and hyperplastic prostate
    Robel, P; Eychenne, B; Blondeau, J.P
  • Finasteride (MK-906) in the treatment of benign prostatic hyperplasia
  • Finasteride in the treatment of benign prostatic hyperplasia
    Kirby, R.S; Bryan, J; Eardley, I
  • Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride
    Boyle, P; Gould, A.L; Roehrborn, C.G
  • Treatment with finasteride following radical prostatectomy for prostate cancer
    Andriole, G; Lieber, M; Smith, J
  • Serum prostate specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia
    Roehrborn, C.G; Boyle, P; Gould, A.L
  • Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer
    Andriole, G.L; Guess, H.A; Epstein, J.I

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