Benign prostatic hyperplasia combination therapy

McConnell JD, Roehrborn CG, Bautista OM et al. The long term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl 1 Med 2003 349 2387-2398. 

Because data suggest that doxazosin (and probably other oq-receptor blockers) are not as protective against CV events as other therapies, they should be reserved as alternative agents for unique situations, such as men with benign prostatic hyperplasia. If used to lower BP in this situation, they should only be used in combination with primary antihypertensive agents. 

Striking evidence of the association of finasteride with male breast cancer comes from the Medical Therapy of Prostatic Symptoms (MTOPS) study, a National Institutes of Health (NIH)-sponsored study of about 3047 men that compared finasteride, doxazosin, and the combination for the treatment of benign prostatic hyperplasia. The rate of breast cancer in this trial for men taking finasteride either alone or with doxazosin was four in 1554, or nearly 200 times that of the general population one man in the finasteride + doxazosin group and three in the finasteride-alone group developed male breast cancer (74). 

Inaba M, Otani Y, Nishimura K, Takaha N, Okuyama A, Koga M, Azuma J, Kawase I, Kasayama S. Combination therapy with rofecoxib and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia. Metab Clin Exp 2005 54 55-9. 

A recent survey demonstrated that one third of men choosing nonsurgical therapy for benign prostatic hyperplasia were using herbal preparations alone or in combination with prescription medications. There is emerging evidence that several plant extracts are well tolerated and provide at least short-term improvement in urologic symptoms and flow. 

Kirby R, Roehrborn CG, Boyle P, et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 2003 61 119-126. 

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