Rates of prostate surgery and acute urinary retention for benign prostatic hyperplasia in men treated with dutasteride or finasteride

Abstract

BackgroundPrevious studies have suggested a greater benefit for various outcomes in men diagnosed with benign prostatic hyperplasia (BPH) who are treated with dutasteride than for men treated with finasteride. This study investigates whether the rates of BPH-related prostate surgery and acute urinary retention (AUR) differ between dutasteride and finasteride users in the Netherlands.MethodsFrom the PHARMO Database Network, men aged ≥50 years with a dispensing of dutasteride or finasteride with or without concomitant alpha-blocker treatment between March 1, 2003 and December 31, 2011 were selected. The incidence of BPH-related prostate surgery and AUR was determined during dutasteride or finasteride treatment and stratified by type of initial BPH-treatment (5-ARI monotherapy or combination with alpha-blocker) and prescriber (general practitioner (GP) or urologist). Comparison of the incidence of BPH-related prostate surgery and AUR between the treatment groups was done by Cox proportional hazard regression.Results11,822 dutasteride users and 5,781 finasteride users were identified. Most users started treatment in combination with an alpha-blocker. Overall, dutasteride users had a lower risk of BPH-related prostate surgery was lower among dutasteride users than finasteride users (HR: 0.75; 95 % CI: 0.56–0.99). This lower risk among dutasteride users was also seen when stratifying by monotherapy or combination therapy (HR: 0.73; 95 % CI: 0.54–0.98 for monotherapy and HR: 0.85; 95 % CI: 0.74–0.97 for combination therapy). However, the association was only present among men treated by urologists. For AUR the rates were low and no statistical significant difference was observed between dutasteride and finasteride users.ConclusionsThe risk of undergoing BPH-related prostate surgery was lower among men using dutasteride compared to men using finasteride. The association was observed for monotherapy as well as combination therapy, however, only among men who received their prescription from a urologist.

Atorvastatin attenuates testosterone‐induced benign prostatic hyperplasia in rats: role of peroxisome proliferator‐activated receptor‐γ and cyclo‐oxygenase‐2

“…Benign prostatic hyperplasia (BPH) is the most common benign tumor in men . By 50 years of age, up to 50% of men may have histologically distinguished BPH with reported prevalence increasing to 90% by age 90 .…”

Management of urinary retention in patients with benign prostatic obstruction: A systematic review and meta-analysis

“…Data from five studies, which evaluated the long-term use of a1-blockers, showed that patients receiving a1-blockers had a significantly lower risk of recurrent AUR [14]. The use of 5a reductase inhibitors (5ARIs) as a combination therapy with a1-blockers in AUR treatment is still controversial [15,16]. Urgent prostatic surgery is another therapeutic option for AUR, however with a higher risk of intra-and/or postoperative complications and mortality than elective surgery [17].…”

Alpha‐1 adrenergic antagonists, 5‐alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: A systematic review and meta‐analysis of urodynamic studies

“…Finasteride inhibits only 5α‐reductase type 2, whereas dutasteride inhibits 5α‐reductase types 1 and 2 with similar potency . Subsequently, dutasteride induces a deeper suppression of serum DHT with respect to finasteride (90% vs 70%) . Moreover, dutasteride has a longer half‐life compared to finasteride (approximately 4 weeks vs 6 h) .…”

“…Until the early 90s, the choice of therapy in patients with LUTS/BPO consisted of either watchful waiting or surgical treatment. Currently, medical therapy is considered the first‐line option for men with moderate to severe LUTS/BPO . Four classes of drugs are available that can potentially improve BPO through various mechanisms of actions: alpha‐1 adrenergic antagonists (ABs), 5‐alpha reductase inhibitors (5‐ARIs), phosphodiesterase type 5 inhibitors (PDE5is), and phytotherapic compounds …”