The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia

Lepor, Herbert; Williford, William O.; Barry, Michael J.; Brawer, Michael K.; Dixon, Christopher; Gormley, Glenn J.; Haakenson, Clair; Machi, Madeline; Narayan, Perinchery; Padley, Robert J.

doi:10.1056/nejm199608223350801

Cited by 708 publications

(247 citation statements)

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“…19 However, comparative study results are not very commended about phytotherapy. The ef®cacy of Serenoa repens appears to be similar to that of ®nasteride, 10 but the fact that the ef®cacy of ®nasteride over placebo has been questioned, 4 makes the results of this comparative study, which lacked a placebo arm to demonstrate superior ef®cacy of both Serenoa repens and ®nasteride over placebo, less impressive. 11 Two other comparative studies 20,21 between an a 1 -adrenoceptor antagonist and a phytotherapeutic agent have shown that at least in the short-term, a 1 -adrenoceptor antagonists appear to improve symptoms better.…”

Section: Discussionmentioning

confidence: 91%

Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France

Vallancien

Pariente

2001

Prostate Cancer Prostatic Dis

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The objective of this work is to describe the pro®le of prevalent and incident populations suffering from lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to analyse the management of care by 620 general practitioners (GPs) in France in 1997 and 1998. Patient records were extracted from the THALES database. Special attention was given to the use of medical therapy and switch rates (ie change to another or combination with another drug). In real life practice (RLP) French GPs predominantly utilise a 1 -adrenoceptor antagonists for the treatment of LUTS. This is in agreement with available evidence from randomised controlled trials (RCTs) with different medical therapies (a 1 -adrenoceptor antagonists, ®nasteride, plant extracts). On the contrary, the relatively high usage of phytotherapy might be explained by traditional and personal preferences. Using purely descriptive statistics, newer a 1 -adrenoceptor antagonists, alfuzosin and tamsulosin, seem to be the most frequently prescribed medical therapy for new patients and are, moreover, associated with a low switch rate. Prostate Cancer and Prostatic Diseases (2001) 4, 124±131.

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Section: Discussionmentioning

confidence: 91%

Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France

Vallancien

Pariente

2001

Prostate Cancer Prostatic Dis

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“…Symptomatic relief is thought to be due to the 17-30% reduction in prostate volume after fimasteride treatment lasting 6 months or longer (Gormley et al 1992;Stoner et al, 1994a: Anderson et al 1995Geller. 1995;Lepor et al 1996). The goal of our study was to examine the biological effects of finasteride on the epithelium of the prostate.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment w-ith finasteride in men w-ith benign prostatic hxperplasia (BPH) has been associated with a 17-30%c reduction in prostate Xolume (averaae 19%k) and a 50% decrease in circulatinc lexvels of prostate-specific antigen (PSA (Gormlev et al 1992: Stoner et al 1994a: Anderson et al 1995: Geller. 1995: Lepor et al 1996. The short-term side-effects of finasteride treatment wxere minimal.…”

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confidence: 99%

The effect of finasteride on the prostate gland in men with elevated serum prostate-specific antigen levels

Côté

Skinner²,

Salem³

et al. 1998

Br J Cancer

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Summary Prostate cancer is a disease associated with androgens. It has been hypothesized that reducing the conversion of testosterone (T) to dihydrotestosterone (DHT) in the prostate by the use of the drug finasteride. a 5a-reductase inhibitor, will reduce the incidence of prostate cancer. We investigated the chemopreventive potential of finasteride by evaluating its effect on the prostate gland of men with elevated serum prostate-specific antigen (PSA). Fifty-two men with elevated PSA and prostate sextant biopsies negative for cancer were randomized to receive finastende 5 mg day-, (27 patients) or no medication (25 patients) for 12 months and were rebiopsied at 12 months.The biopsies were evaluated for the presence of cancer, the proportion of glandular and hyperplastic tissue, and the presence of high-grade prostatic intraepithelial neoplasia (PIN). Epithelial proliferation was assessed in the prestudy and 12-month biopsies by immunohistochemistry using antibody to proliferating cell nuclear antigen (PCNA). Serum blood samples were drawn at baseline and after 1. 3, 6 and 12 months of study. In the control group, serum levels of PSA and T were unchanged throughout the 12 months. In the finastende group, PSA decreased 48°o (P < 0.001), DHT decreased 670o (P < 0.001) and T increased 21 0°(P < 0.001). Histological evaluation of prestudy and 12-month biopsy specimens revealed that the finasteride group had a 300% reduction in the percentage of hyperplastic epithelial tissue (P = 0.002). although this decrease was not statistically significantly different between the finasteride and control groups (P = 0.11). In patients with PIN on prestudy biopsy, no change occurred in the PIN lesions with finasterde treatment. Finasteride also had no effect on the proliferation index of prostatic epithelial cells. Of the 27 patients treated with finastende, eight (309O) had adenocarcinoma of the prostate detected on the 12-month biopsy. compared with one (40o) of the control patients (P = 0.025). In the treatment group, six cancers occurred in the eight patients with PIN on the prestudy biopsy: in the observation group no cancers were detected in the five patients with PIN on the prestudy biopsy (P= 0.021). Two cancers occurred in the 19 men in the treatment group with no evidence of PIN on the prestudy biopsy. compared with one cancer in the 20 men in the observation group with no evidence of PIN on the prestudy biopsy (P = 0.60). This study, using a novel model for evaluating short-term efficacy of chemopreventive or therapeutic agents in men at high nsk of prostate cancer. provides little evidence that finasteride is an effective chemopreventive agent for prostate cancer in men with elevated PSA. Keywords: finastende: prostate carcinoma: intraepithelial neoplasia: proliferation Carcinoma of the prostate is the most frequentl diagnosed cancer in the US. Although the most important risk factor for prostate cancer is age (Ross et al. 1979). there is also profound -ariation in incidence between different racial groups in the US....

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“…But there is no doubt that for an unselected population of men with lower urinary tract symptoms, the alpha blockers provide a quicker, more reliable and more signi®cant short term symptom relief than does ®nasteride. 15 The rationalization of medical therapy, however, comes from a critical look at the not only at the short term effects but also the side effect pro®le, long term effects, selection implications and consequence of therapy on long term associated outcomes ( Table 1). …”

Section: The Problemmentioning

confidence: 99%

“…How then does one explain the inconsistent results seen in the Veterans Administration BPH trial 15 ? In this landmark study, the ef®cacy of terazosin was con®rmed while ®nasteride was found to be marginally better than placebo.…”

Section: Does Prostate Size Make a Difference?mentioning

confidence: 99%

Medical therapy for BPH: expanding our treatment paradigm?

Nickel

1999

Prostate Cancer Prostatic Dis

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Medical therapy for relief of symptoms of benign prostatic hyperplasia (BPH) is now a clinical reality. The challenge for urologists treating BPH with medical therapy is how to rationally employ the two proven classes of medications, the alpha blockers and ®nasteride, in their practice. To accomplish this, we must critically examine the results of multiple important clinical BPH trials published over the last decade and examine the short and long term effect of the various available medical therapies on symptoms, objective progression and consequences of the disease process and whether evidence based indicators will allow us to choose appropriate therapies. It appears that we can rationalize our medical therapy decisions, taking into consideration severity of disease, prostate size (and perhaps PSA) and most importantly, the patients' longterm expectations for treatment outcome. But ®rst physicians must decide for themselves whether to expand their treatment paradigm beyond short term symptom relief to encompass long term durability and even prevention of the consequences of the long term progression of BPH.Keywords: benign prostatic hyperplasia; prostate; ®nasteride; alpha blockers The challengeDuring the last decade medical therapy for benign prostatic hyperplasia (BPH) has become a clinical reality. 1 Two classes of medication have emerged with consistently proven results in randomized controlled trials as better than placebo: the alpha-blockers and the 5-alphareductase inhibitors. Well designed studies have proven that these medications are both safe and effective over the short term (1 y).The challenge for urologists treating BPH with medical therapy is how to rationally employ these medications in their practice. To tackle this task we must ask a number of fundamental questions: Is BPH a long term progressive disease? Should the solution for this disease with medical therapy be viewed not in terms of weeks, months or even a year, but rather be considered a life time treatment for the patient? As surgeons we have always been most interested in short term symptom relief. But now, should we be convinced that that therapy is safe over the long term, has long term ef®cacy compared to placebo, is durable over years and even decades, hopefully has the ability to halt the progression of the disease and prevent complications such as acute urinary retention or the requirement for surgery? The ultimate challenge is whether we as a urological community are ready to expand beyond short term symptom relief to long term symptom control and perhaps even prevention of disease progression with its associated complications. The problemIt appears, that in many (but certainly not all) patients with lower urinary tract symptoms, BPH can indeed be considered a slowly progressive disease. The prostate gland increases in size at an average rate of 0.6 ml/y with some age variation. 2 The average decrease in¯ow rate over time, which is an indirect measure of obstruction, is about 2 ml/sec/decade. 3,4 The frequency and severity of sy...

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The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia

Abstract: In men with benign prostatic hyperplasia, terazosin was effective therapy, whereas finasteride was not, and the combination of terazosin and finasteride was no more effective than terazosin alone.

Cited by 708 publications

References 19 publications

Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France

Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France

The effect of finasteride on the prostate gland in men with elevated serum prostate-specific antigen levels

Medical therapy for BPH: expanding our treatment paradigm?

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