A risk-benefit assessment of treatment with finasteride in benign prostatic hyperplasia

Ekman, P.
March 1998
Drug Safety;Mar1998, Vol. 18 Issue 3, p161
Academic Journal
journal article
As an androgen target organ, the prostate gland has the almost unique characteristic of being less sensitive to testosterone than to its metabolite 5α-dihydrotestosterone (5α-DHT). The conversion of testosterone to 5α-DHT is induced by the enzyme 5α-reductase. By blocking the activity of 5α-reductase, the androgenic stimulation of the prostate gland can be significantly reduced. The first drug with such capacity to be introduced on the market was finasteride. Following the administration of this drug to men, serum 5α-DHT levels were reduced by approximately 80%. Large phase III trials have demonstrated the efficacy of finasteride in treating benign prostatic hyperplasia (BPH). While in some patients the drug was poorly effective, other patients showed significant improvements. The mean reduction in size of the prostate gland was 20 to 25% after 6 months of therapy, and this effect was maintained as long as the patient was on the drug, at least up to the end of a 6-year follow-up period. Prostatic symptom scores were improved by a mean of 30%, while urinary flow was only improved by a mean of 1.5 ml/sec (15%). In a recent double-blind, placebo-controlled study comparing the α-blocker terazosin with finasteride, significant improvement was demonstrated for the α-blocker, while finasteride produced little improvement overall and was not significantly more effective than placebo in treating moderately symptomatic BPH. However, a subanalysis of this study showed that while finasteride was poorly effective in patients with small prostate glands, a significant improvement was apparent in those with glands larger than 40ml. There is some evidence that early intervention with finasteride can reduce the number of surgical procedures that are required, at least over a 2-year period. Finasteride is very well tolerated. However, since 5α-DHT potentiates erectile capacity, a 3 to 4% incidence of impotence has been reported, as well as a decreased ejaculatory volume. Gynaecomastia has been noted in a few patients (0.4%). In conclusion, finasteride appears to be a very well tolerated drug to treat outflow obstruction in patients with moderately symptomatic BPH caused by large prostate glands.


Related Articles

  • Independent Nurse: Clinical Focus - Benign prostatic hyperplasia. Rees, Rowland // GP: General Practitioner;11/27/2009, p21 

    The article presents information related to Benign Prostatic Hyperplasia (BPH), which occurs due to an increase in epithelial and stromal cells in the peri-urethral area of the prostate. It has been stated that BPH could be detected by performing urinalysis. It has also been reported that...

  • Advances in the medical management of benign prostatic hyperplasia. Jewett, Michael A. S.; Klotz, Laurence H. // CMAJ: Canadian Medical Association Journal;6/19/2007, Vol. 176 Issue 13, p1850 

    The article discusses the advancement in the medical management of benign prostatic hyperplasia (BPH) in men. The results from the Medical Therapy of Prostatic Symptoms found that the use of doxazosin in combination with finasteride slowed down the clinical progression of BPH, particularly in...

  • Role of 5-alpha reductase inhibitors in the prevention of prostate cancer. Singh, Bhupendra P.; Sankhwar, S. N.; Goel, Apul // Indian Journal of Urology;Jan-Mar2011, Vol. 27 Issue 1, p153 

    In this 4-year, multicenter, randomized, double-blind, placebo-controlled trial, authors compared the dutasteride (0.5 mg daily) with the placebo. Inclusion criteria were men of 50-75 years of age with a prostate-specific antigen (PSA) level of 2.5-10.0 ng/ml, who had one negative prostate...

  • 5α-Reductase.  // Encyclopedic Reference of Molecular Pharmacology;2004, p31 

    A definition of the term "5α-reductase" is presented. It is an enzyme that converts testosterone to dihydrotestosterone, and it has a greater affinity for androgen receptors. Various peripheral organs express 5-α-reductase. Finasteride and other 5-α-reductase inhibitors are used to...

  • PAE Safe, Effective for BPH.  // Renal & Urology News;Dec2013, Vol. 12 Issue 12, p22 

    The article reports on an early clinical trial conducted by Sandeep Bagla and colleagues which reveals that prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia (BPH).

  • Patients with a large prostate show a higher prevalence of androgenetic alopecia. WenChieh Chen; Chao-Chun Yang; Guan-Yu Chen; Meng-Chie Wu; Hamm-Ming Sheu; Tzong-Shin Tzai // Archives of Dermatological Research;Nov2004, Vol. 296 Issue 6, p245 

    Androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH) are both androgen-dependent disorders, displaying in situ high levels of dihydrotestosterone with a good therapeutic response to finasteride. Embryological development of both the hair follicle and the prostate depends on...

  • 5-ARI efficacious regardless of BPH symptom severity. Bankhead, Charles // Urology Times;Dec2010, Vol. 38 Issue 13, p20 

    The article focuses on treatment of men for prostate cancer with dutasteride. It states that treatment with the 5-alpha-reductase inhibitor reduces the incidence of surgery. It states that moderate symptoms and larger prostates can double the risks of surgery in placebo treated patients and...

  • FINASTERIDE FOR BPH. Johnson, Kenneth H.; Casey, Cynthia M. // Journal of Family Practice;Jun1998, Vol. 46 Issue 6, p455 

    The article reviews the study "The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment Among Men With Benign Prostatic Hyperplasia," by J. D. McConnell, R. Bruskewitz, P. Walsh et al, which appeared in a 1998 issue of the "New England Journal of...

  • BPH drug shows efficacy in treating female hair loss. Moftah, N; Moftah, N.; Abd-Elaziz, G // Contemporary OB/GYN;May2012, Vol. 57 Issue 5, p16 

    The article reports an Egyptian study that shows mesotherapy with dutasteride, used to treat benign prostatic hyperplasia, has proved to be effective in improving hair density, thickness, texture and color in women patients with female pattern hair loss (FPHL).


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics