5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia
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How It Works
5-alpha reductase inhibitors interfere with the effect of certain male hormones (androgens) on the prostate. This slows the growth of the prostate and can even cause it to become smaller, which may help improve the symptoms of benign prostatic hyperplasia (BPH).
But since prostate size does not always correspond to the severity of a man's symptoms, these medicines will not give satisfactory results in every case.
When you stop taking the medicine, symptoms usually return.
Why It Is Used
5-alpha reductase inhibitors are used to keep symptoms of BPH from getting worse. They are also used to reduce the risk of being unable to urinate (urinary retention) and to prevent surgery for BPH.
5-alpha reductase inhibitors are also used to treat the symptom of blood in the urine because of BPH.
5-alpha reductase inhibitors are not recommended for men who have BPH symptoms without a noticeably enlarged prostate. 5-alpha reductase inhibitors may be prescribed for men who have bothersome, moderate symptoms of BPH.
How Well It Works
5-alpha reductase inhibitors also decrease the risk of complications, such as being unable to urinate (urinary retention). And they make it less likely that you will need surgery.2
It may take 6 to 12 months before you notice that your symptoms have improved.
Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor long-term may help your symptoms more than either medicine alone.3
Side effects may include:
- Decreased sex drive.
- Increased ejaculatory dysfunction (such as a smaller amount of semen ejaculated).
- Difficulty getting an erection.
- Breast tenderness or enlargement.
These side effects may go away after a year or more of taking the medicine.
It is possible that 5-alpha reductase inhibitors are linked to an increased risk for high-grade prostate cancers. But more research is needed.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
5-alpha reductase inhibitors reduce the size of the prostate. But since a smaller size does not always relieve symptoms, these medicines will not give satisfactory results in every case. When you stop taking the medicine, symptoms usually return.
5-alpha reductase inhibitors lower prostate-specific antigen (PSA) levels. Because PSA levels are used to detect early-stage prostate cancer, men interested in taking a 5-alpha reductase inhibitor might consider the following:
- Most experts suggest that men be checked for the presence of prostate cancer (using the PSA test and a digital rectal exam) before taking 5-alpha reductase inhibitors.
- Follow-up PSA levels that have not decreased by approximately 50% after 6 months of taking a 5-alpha reductase inhibitor may point to the need for further testing for prostate cancer.
- PSA levels above 2 ng/mL (nanograms per milliliter) during 5-alpha reductase inhibitor treatment may point to the need for further testing for prostate cancer.
5-alpha reductase inhibitors are not recommended for treatment of BPH symptoms in men who do not have an enlarged prostate.1
The medicine must be taken for the rest of your life to prevent the symptoms from coming back.
This medicine should not be used by men who plan to father a child, because there is a small chance that the medicine could cause a birth defect. Women who are pregnant or might become pregnant should not handle broken or crushed tablets of finasteride or dutasteride.
- AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
- McNicholas T, Kirby R (2011). Benign prostatic hyperplasia, search date July 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Roehrborn CG, et al. (2008). The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. Journal of Urology, 179(2): 616–621.
Last Revised: March 5, 2012
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