5-alpha-reductase inhibitors (5ARI) for benign prostatic hyperplasia
A Cochrane review 1 on finasteride for benign prostatic hyperplasia included 23 studies with a total of 21,945 subjects. Finasteride consistently improved urinary symptom scores more than placebo in trials of > 1 year duration (4 studies), and significantly lowered the risk of BPH progression (acute urinary retention, risk of surgical intervention, ≥ 4 point increase in the AUASI/IPSS). There was an increased risk of ejaculation disorder, impotence, and lowered libido for finasteride versus placebo.
A systematic review 2 including 11 studies with a total of 13,822 subjects was abstracted in DARE. Reductions in prostate volume, increases in urinary flow rates and improvements in symptoms compared with placebo have been observed in trial of up to 4 years´ duration and in noncomparative extensions (up to 6 years). Results from the PLESS trial show finasteride to significantly reduce the risk of acute urinary retention and requirement for surgical intervention. Similar efficacy has been reported with the novel 5-ARI dutasteride which inhibits both subtype I and subtype II 5-alpha-reductase.
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