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Drug Insight: 5α-reductase inhibitors for the treatment of benign prostatic hyperplasia

Nature Clinical Practice Urology volume 3, pages 495–503 (2006)Cite this article

Abstract

Benign prostatic hyperplasia (BPH) is a common problem among older men, which is characterized by an enlarged prostate, lower urinary tract symptoms, and decreased flow of urine. It is a progressive disease that can lead to complications such as acute urinary retention (AUR) or a need for BPH-related surgery in some men. Dihydrotestosterone is the primary androgen involved in both normal and abnormal prostate growth and 5α-reductase inhibitors (5ARIs) inhibit the conversion of testosterone to dihydrotestosterone. There are two 5ARIs licensed for the treatment of BPH; dutasteride, which inhibits both type 1 and type 2 isoenzymes of 5α reductase, and finasteride, which inhibits the type 2 isoenzyme. Both 5ARIs have been shown to decrease prostate volume, improve urinary flow and lower urinary tract symptoms and reduce the risk of AUR and BPH-related surgery. The prevention of disease progression, by treating the underlying cause, and the alleviation of symptoms are important aims of BPH therapy. 5ARIs are the only currently available medical therapy that can reduce the risk of AUR and BPH-related surgery while providing long-term symptom control. This provides a mandate for their use in men with enlarged prostates (volume ≥30 ml), who are at increased risk of disease progression.

Key Points

  • Benign prostatic hyperplasia (BPH) is characterized by an enlarged prostate, lower urinary tract symptoms, and a decreased flow of urine

  • BPH is a progressive disease that can lead to complications such as acute urinary retention or a need for surgery to alleviate obstruction

  • The prevention of BPH progression and the alleviation of symptoms are important aims of BPH therapy

  • 5α-reductase inhibitors are the only currently available medical therapy that can reduce the risk of acute urinary retention and the need for BPH-related surgery

  • 5α-reductase inhibitors are recommended for use in men who are at an increased risk of BPH progression (prostate volume ≥30 ml, PSA level >1.4 ng/ml)

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Figure 1: Proposed algorithm for medical therapy of BPH.

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Acknowledgements

Medical writing assistance was provided by HM Williams.

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Authors and Affiliations

  1. Professor and Chairman of the Department of Urology at the University of Vienna, Vienna, Austria

    Michael Marberger

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Correspondence to Michael Marberger.

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Competing interests

The author is a study participant and speaker at symposia (with honorarium) for Merck and GlaxoSmithKline, and a consultant for GP Pharma and R. Wolf.

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Marberger, M. Drug Insight: 5α-reductase inhibitors for the treatment of benign prostatic hyperplasia. Nat Rev Urol 3, 495–503 (2006). https://doi.org/10.1038/ncpuro0577

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