Benign prostatic hyperplasia, treatment finasteride

Boyle P, Gould AL, Roehrborn CG. Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride Meta-analysis of randomized clinical trials. Urology 1996 48 398 05. 

One final area where steroids are used is as antiandrogens in the treatment of benign prostatic hyperplasia, prostate cancer and male hypersexuality. Dutasteride and finasteride (Fig. 20.34) are specific inhibitors of 5a-reductase, which is involved in the metabolism of testosterone. These two compounds are indicated for the treatment of benign prostatic hyperplasia, with finasteride also being indicated for male-pattern baldness. 

Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia a randomized international study of 1098 patients. Prostate 4 231-240, 1996. 

Geriatric Considerations - Summary Alpha-adrenergic blockers are modestly effective alone, and in combination with 5-alpha reductase inhibitors (e,g, finasteride) in the treatment of urinary obstructive symptoms related to benign prostatic hyperplasia. Alfuzosin is a "uroselective" alpha-blockerwhich appears to cause less orthostatic hypotension than nonselective alpha-blockers such as terazosin, prazosin, and doxazosin. 

Finasteride is a selective inhibitor of 5-alpha-reductase. It thereby reduces prostatic concentrations of dihydrotestosterone and so reduces prostatic size (6,7,8). It is therefore used to treat benign prostatic hyperplasia (9,10,11,12) and in the prevention and treatment of prostate cancer (13). It is poorly effective in patients with prostatic obstruction and small prostate glands (14), but in patients with glands larger than 40 ml it produces significant symptomatic improvement. 

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). 

Peters DH, Sorkin EM. Finasteride. A review of its potential in the treatment of benign prostatic hyperplasia. Drugs 1993 46(l) 177-208. 

Edwards JE, Moore RA. Finasteride in the treatment of clinical benign prostatic hyperplasia a systematic review of randomised trials. BMC Urol 2002 2 14. 

Ekman P. A risk-benefit assessment of treatment with finasteride in benign prostatic hyperplasia. Drug Saf 1998 18 161-70. 

De Bruyne FMJ, Jardin A, Colloi D, Resel L, Witjes WPJ, Delauche-Cavallier MC, McCarthy C, Geffriaud-Ricouard C. Sustained release alfuzosin, finasteride and the combination of both in the treatment of benign prostatic hyperplasia. Eur Urol 1998 34 169-75. 

Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC, Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia a randomized international study of 1,098 patients. Prostate I996 29(4) 23 I K). 

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. 

Lam JS, Romas NA, Lowe FC. Long-term treatment with finasteride in men with symptomatic benign prostatic hyperplasia 10-year follow-up. Urology 2003 61 354-8. 

Lipophilic extracts of sabal fruit (Serenoa repens syn. Sabal seruulata) are used in the treatment of benign prostatic hyperplasia (BPH) (see Chapter 55). The hexane extract of the pulp and seed contains a complex mixture of free fatty acids and their esters, small quantities of phytosterols (such as [3-sitosterol), aliphatic alcohols, and polyprenic compounds. The efficacy of this extract was recently compared with that of the 5a-reductase inhibitor finasteride for 6 months, in a randomized, double-blind trial involving almost 1100 men with moderate BPH. Dwarf palm and finasteride reduced the International Prostate Symptom Score by 37 and 39% and increased urinary peak flow by 2.7 and 3.2 ml/sec, respectively. In contrast to finasteride, dwarf palm had little effect on prostate volume. 

Saw palmetto is most often used in the treatment of benign prostatic hyperplasia. Enzymatic conversion of testosterone to dihydrotestosterone (DHT) by 5a-reductase is inhibited by saw palmetto in vitro. This effect is similar to that of finasteride, which is also used to treat the disorder (Chapter 40 The Gonadal Hormones Inhibitors). In vitro, saw palmetto also inhibits the binding of DHT to androgen receptors. Additional effects that have been observed in vitro include inhibition of prostatic growth factors, blockade of ay-adrenoceptors, and inhibition of inflammatory mediators... 

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. 

McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998 338 557-563. 

The aromatase converts testosterone into estradiol. Part of the testosterone (7%) is reduced to 5a-dihydrotestosterone (DHT), which strongly activates the androgen receptor (AR). 5a-DHT inhibitors such as finasteride are involved in the treatment of benign prostate hyperplasia. 

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