Tags

Type your tag names separated by a space and hit enter

A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate.
Clin Ther. 2007 Jan; 29(1):17-25.CT

Abstract

BACKGROUND

Enlargement of the prostate is common among aging men, with an incidence of 90% by the age of 85 years. It is a progressive condition, with growth in prostate size accompanied by lower urinary tract symptoms that can result in long-term complications (eg, acute urinary retention [AUR], need for enlarged prostate-related surgery). Current pharmacologic treatment options include alpha-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin) and 5alpha-reductase inhibitors (5ARIs) (finasteride and dutasteride).

OBJECTIVES

This article reviews the natural history of enlarged prostate and the data supporting management of this condition with alpha-blocker and 5ARI therapy, either as monotherapy or combination therapy, for symptomatic relief and a reduction in long-term disease progression.

METHODS

Pertinent English-language articles were identified through a search of MEDLINE (1966-week 2, May 2006) using such search terms as 5alpha-reductase inhibitor, alpha-blocker, benign prostatic hyperplasia, dutasteride, efficacy, enlarged prostate, finasteride, and safety.

RESULTS

Clinical trials of alpha-blockers in men with enlarged prostate have reported improvements in total symptom scores of 10% to 20% compared with placebo; however, these agents were not shown to reduce the risk of long-term complications or disease progression. Studies of the 5ARIs have reported significant reductions compared with placebo in the relative risk for AUR and enlarged prostate-related surgery, slowing of disease progression, and relief of symptoms. In studies of dutasteride, improvements in symptom scores were greater after 4 years of therapy compared with 2 years (-6.4 vs -4.3 points, respectively) and flow rates were better (2.6 vs 2.3 mL/sec). Six-year data for finasteride showed maintenance of the decreased risk for AUR and enlarged prostate-related surgery. Use of combination therapy with an alpha-blocker and a 5ARI may be of benefit in patients who require immediate relief of symptoms, with discontinuation of the alpha-blocker after several months of therapy. 5ARIs were generally well tolerated, with sexual dysfunction the most frequently reported adverse effect, although in only a small proportion of men (1%-8%).

CONCLUSIONS

The use of 5ARI therapy is a rational approach to symptom management and prevention of long-term negative outcomes in men with enlarged prostates.V 3.

Authors+Show Affiliations

University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mnaslund@smail.umaryland.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17379044

Citation

Naslund, Michael J., and Martin Miner. "A Review of the Clinical Efficacy and Safety of 5alpha-reductase Inhibitors for the Enlarged Prostate." Clinical Therapeutics, vol. 29, no. 1, 2007, pp. 17-25.
Naslund MJ, Miner M. A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clin Ther. 2007;29(1):17-25.
Naslund, M. J., & Miner, M. (2007). A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clinical Therapeutics, 29(1), 17-25.
Naslund MJ, Miner M. A Review of the Clinical Efficacy and Safety of 5alpha-reductase Inhibitors for the Enlarged Prostate. Clin Ther. 2007;29(1):17-25. PubMed PMID: 17379044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. AU - Naslund,Michael J, AU - Miner,Martin, PY - 2006/12/01/accepted PY - 2007/3/24/pubmed PY - 2007/8/8/medline PY - 2007/3/24/entrez SP - 17 EP - 25 JF - Clinical therapeutics JO - Clin Ther VL - 29 IS - 1 N2 - BACKGROUND: Enlargement of the prostate is common among aging men, with an incidence of 90% by the age of 85 years. It is a progressive condition, with growth in prostate size accompanied by lower urinary tract symptoms that can result in long-term complications (eg, acute urinary retention [AUR], need for enlarged prostate-related surgery). Current pharmacologic treatment options include alpha-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin) and 5alpha-reductase inhibitors (5ARIs) (finasteride and dutasteride). OBJECTIVES: This article reviews the natural history of enlarged prostate and the data supporting management of this condition with alpha-blocker and 5ARI therapy, either as monotherapy or combination therapy, for symptomatic relief and a reduction in long-term disease progression. METHODS: Pertinent English-language articles were identified through a search of MEDLINE (1966-week 2, May 2006) using such search terms as 5alpha-reductase inhibitor, alpha-blocker, benign prostatic hyperplasia, dutasteride, efficacy, enlarged prostate, finasteride, and safety. RESULTS: Clinical trials of alpha-blockers in men with enlarged prostate have reported improvements in total symptom scores of 10% to 20% compared with placebo; however, these agents were not shown to reduce the risk of long-term complications or disease progression. Studies of the 5ARIs have reported significant reductions compared with placebo in the relative risk for AUR and enlarged prostate-related surgery, slowing of disease progression, and relief of symptoms. In studies of dutasteride, improvements in symptom scores were greater after 4 years of therapy compared with 2 years (-6.4 vs -4.3 points, respectively) and flow rates were better (2.6 vs 2.3 mL/sec). Six-year data for finasteride showed maintenance of the decreased risk for AUR and enlarged prostate-related surgery. Use of combination therapy with an alpha-blocker and a 5ARI may be of benefit in patients who require immediate relief of symptoms, with discontinuation of the alpha-blocker after several months of therapy. 5ARIs were generally well tolerated, with sexual dysfunction the most frequently reported adverse effect, although in only a small proportion of men (1%-8%). CONCLUSIONS: The use of 5ARI therapy is a rational approach to symptom management and prevention of long-term negative outcomes in men with enlarged prostates.V 3. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/17379044/A_review_of_the_clinical_efficacy_and_safety_of_5alpha_reductase_inhibitors_for_the_enlarged_prostate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(07)00032-X DB - PRIME DP - Unbound Medicine ER -