Combined analysis of two multicenter studies of finasteride 5 mg in the treatment of symptomatic benign prostatic hyperplasia The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group. Finasteride in the treatment of benign prostatic hyperplasia. A urodynamic evaluation. Eliciting preferences for drug treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. Finasteride in the treatment of benign prostatic hyperplasia. Long-term (7 to 8-year) experience with finasteride in men with benign prostatic hyperplasia. Pharmacotherapy of benign prostatic hyperplasia: Inhibitor of 5 alpha-reductase Combination therapy with dutasteride and tamsulosin in men with moderate-to-severe benign prostatic hyperplasia and prostate enlargement: the CombAT (Combination of Avodart and Tamsulosin) trial rationale and study design. Proscar: five-year experience. Maintenance of clinical efficacy with finasteride therapy for 24 months in patients with benign prostatic hyperplasia. The Finasteride Study Group. Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized double-blind controlled trial. Five-year follow-up of patients with benign prostatic hyperplasia treated with finasteride. The effect of finasteride on prostate volume, urinary flow rate and symptom score in men with benign prostatic hyperplasia. The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. Prostate tissue composition and response to finasteride in men with symptomatic benign prostatic hyperplasia. Urodynamic effects of finasteride in the treatment of bladder outlet obstruction due to benign prostatic hyperplasia. Comparison of the efficacy and safety of finasteride in older versus younger men with benign prostatic hyperplasia.
The purpose of this paper is to examine effects of finasteride 5 mg across different age groups in an ethnically diverse population of men with symptomatic benign prostatic hyperplasia ( BPH ) seen in community urology and primary care practice s. Data were combined from two previous placebo-controlled r and omised trials of finasteride that evaluated changes in urinary symptoms , blinded global assessment s of urologic status , adverse experiences , and effects on dihydrotestosterone ( DHT ) and prostate-specific antigen ( PSA ) in over 4500 men .  Finasteride showed a favourable efficacy and tolerability profile in this large ethnically diverse population and was similarly effective in middle-aged and older men with BPH and prostate gl and enlargement BACKGROUND Benign prostatic hyperplasia is a progressive , and rogen-dependent disease result ing in enlargement of the prostate gl and and urinary obstruction . Preventing the conversion of testosterone to its tissue-active form , dihydrotestosterone , by inhibiting the enzyme 5 alpha-reductase could decrease the action of and rogens in their target tissues ; in the prostate the result might be a decrease in prostatic hyperplasia and therefore in symptoms of urinary obstruction . METHODS In a double-blind study , we evaluated the effect of two doses of finasteride ( 1 mg and 5 mg ) and placebo , each given once daily for 12 months , in 895 men with prostatic hyperplasia .  Urinary symptoms , urinary flow , prostatic volume , and serum concentrations of dihydrotestosterone and prostate-specific antigen were determined periodically during the treatment period . RESULTS As compared with the men in the placebo group , the men treated with 5 mg of finasteride per day had a significant decrease in total urinary-symptom scores ( P less than 0.001 ) , an increase of 1.6 ml per second ( 22 percent , P less than 0.001 ) in the maximal urinary-flow rate , and a 19 percent decrease in prostatic volume ( P less than 0.001 ) . The men treated with 1 mg of finasteride per day did not have a significant decrease in total urinary-symptom scores , but had an increase of 1.4 ml per second ( 23 percent ) in the maximal urinary-flow rate , and an 18 percent decrease in prostatic volume . The men given placebo had no changes in total urinary-symptom scores , an increase of 0.2 ml per second ( 8 percent ) in the maximal urinary-flow rate , and a 3 percent decrease in prostatic volume . The frequency of adverse effects in the three groups was similar , except for a higher incidence of decreased libido , impotence , and ejaculatory disorders in the finasteride-treated groups . CONCLUSIONS The treatment of benign prostatic hyperplasia with 5 mg of finasteride per day results in a significant decrease in symptoms of obstruction , an increase in urinary flow , and a decrease in prostatic volume , but at a slightly increased risk of sexual dysfunction A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia ( BPH ) were treated in a double-blind , placebo-controlled study with finasteride ( Proscar , MK-906 ) , a 5-alpha reductase inhibitor , 5 mg or 10 mg/day or placebo for 3 months ; subsequently , 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study . In treated patients dihydrotestosterone declined by over 60 % , remaining unchanged with placebo . Symptom scores fell significantly in all 3 groups . Mean maximum flow rates fell slightly in placebo-treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group . After 1 year 's treatment , the reduction in symptom score and increase in flow rate were well maintained ; the mean prostate volume was reduced by 14 % and prostatic specific antigen declined by 28 % . It was concluded that finasteride shows some efficacy in the treatment of BPH , with minimal toxicity , but 12 months of therapy or longer may be necessary to achieve maximal effect PURPOSE There are 2 main medical preparations available for lower urinary tract symptoms result ing from benign prostatic hyperplasia ( BPH ) . Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics . We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a vali date d technique . MATERIAL S AND METHODS A discrete choice experiment was administered to 211 men older than 40 years who were r and omly selected from the general United Kingdom population . Attributes investigated in the discrete choice experiment were time to symptom improvement , sexual and nonsexual side effects , the risks of acute urinary retention ( AUR ) and surgery , cost and prostate size decrease . Using regression analysis the relative importance of these attributes , the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated . RESULTS All attributes were important to respondents . The most important attribute was side effects . The least preferred side effects was impotence , followed by decreased libido and dizziness . Respondents were willing to wait 13 , 2 and 8 months longer for symptom improvement in exchange for decreased prostate size , and the risks of AUR and surgery , respectively . Men reporting moderate symptoms were less concerned about sexual side effects , time to symptom improvement and the risk of AUR compared with men reporting mild symptoms . CONCLUSIONS Given the attribute levels of BPH medical treatment , overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers . In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH Finasteride is an enzyme inhibitor which blocks the conversion of testosterone by 5 alpha-reductase to dihydrotestosterone , the active and rogenic metabolite in the prostate . In a double-blind , placebo-controlled study , 707 patients with moderately symptomatic BPH were treated for 2 years . The study confirmed that treatment significantly improved symptoms , reduced prostate size and increased urine flow rate . Side effects were usually mild . The authors find that finasteride can reverse the natural progression of BPH OBJECTIVES To evaluate the effects of finasteride , a specific type II 5-alpha-reductase inhibitor , on symptoms of benign prostatic hyperplasia , prostate volume , and urinary flow during a 7 to 8-year period . METHODS A total of 190 men with symptomatic benign prostatic hyperplasia and enlarged prostates entered one of two Phase II double-blind 3 to 6-month studies . Of these , 156 patients continued taking open-label finasteride  , and more than 70 patients completed 7 to 8 years of treatment . The symptoms were scored using a patient self-administered modified Boyarsky symptom question naire . Prostate volume was measured by magnetic resonance imaging or ultrasonography , and the maximal urinary flow rate was assessed noninvasively . RESULTS Treatment with finasteride for 7 to 8 years led to sustained improvement in symptoms , reduction in prostate volume ( 28 % from baseline ) , and increased urinary flow ( median 2.5 mL/s from baseline ) . Decreases in dihydrotestosterone ( 86 % ) and prostate-specific antigen ( 54 % ) levels were also maintained . Long-term finasteride treatment was safe and generally well tolerated . CONCLUSIONS Long-term treatment with finasteride was well tolerated and result ed in durable symptom relief and improvement in prostate volume and urinary flow We studied the effects of 5 alpha-reductase inhibitor ( finasteride ) in the treatment of benign prostatic hyperplasia ( BPH ) . This study is a r and omized controlled trial . Sixty-two patients were treated with 5 alpha-reductase ( finasteride 5 mg/day ) and 61 patients  ( control group )  with placebo for one year . Prostatic volume , maximal urine flow rate , AUA symptom scoring , residual urine volume and prostate-specific antigen ( PSA ) levels were evaluated at 3 , 6 , 9 and 12 months . In the first 6 months prostatic volume decreased rapidly ( 20.5 % ) , in the second 6 months it decreased slowly and reached the maximal rate ( 23.3 % ) . Maximal urine flow rate increased in the second 6 months . AUA symptom scores decreased first at 3 months and were 4.6 points lower at the end of the 12th month . There were no significant changes in residual volume . The 5 alpha-reductase inhibitor caused a 50 % decrease in PSA levels , like in other studies .Becuase of the prolonged use of the drug , treatment with 5 alpha-reductase inhibitor is not tolerated by many patients and being expensive its future in the pharmacotherapy of BPH is unclear Benign prostatic hyperplasia ( BPH ) is a highly prevalent condition in aging men , which can be progressive and lead to acute urinary retention ( AUR ) and the need for surgery . It is commonly treated with alpha-blockers and 5alpha-reductase inhibitors ( 5ARIs ) , both of which improve the symptoms of BPH . Long-term treatment with 5ARIs can also reduce the risk of developing AUR and the need for surgery . The l and mark Medical Therapy of Prostatic Symptoms ( MTOPS ) trial demonstrated that over 4 years the combination of the type 2-specific 5ARI , finasteride and the alpha-blocker doxazosin was more effective than either agent alone in reducing overall clinical progression . Since the initiation of MTOPS , it has been shown that patients with larger prostates and higher prostate-specific antigen ( PSA ) levels are at greater risk of BPH progression , and are therefore arguably more likely to benefit from combination therapy . The Combination of Avodart and Tamsulosin ( CombAT ) trial is a 4-year , global , multicenter , r and omized , double-blind , parallel-group study design ed to investigate the benefits of combination therapy with the dual 5ARI dutasteride and the alpha-blocker tamsulosin compared with each monotherapy in improving symptoms and long-term outcomes in men with moderate-to-severe symptoms of BPH and prostate enlargement .  Symptoms and long-term outcomes ( AUR and surgery ) will be assessed as separate primary endpoints at 2 and 4 years , respectively . Eligible patients were at least 50 years old with prostate volume > or = 30 cm(3 ) and PSA level > or = 1.5 ng/mL. A total of 4838 subjects have been enrolled . This paper describes the rationale , design and baseline data of the CombAT study We assessed the long-term safety and efficacy of finasteride , an orally active 5 alpha-reductase inhibitor , in 2 previously reported groups of patients with symptomatic benign prostatic hyperplasia ( BPH ) . Prostate volume was measured by magnetic resonance imaging , and the maximum urinary flow rate was assessed noninvasively . Symptoms were scored utilizing a patient self-administered symptom score question naire . Total symptom scores ranged from 0 ( or asymptomatic ) to 35 ( severely symptomatic ) . After an initial double-blind period , the patients in study 1 were treated with 10 mg finasteride for 1 year and then switched to 5 mg finasteride for an additional 4 years , whereas patients in study 2 were treated with 5 mg finasteride for the entire 5 years . A total of 190 patients were r and omized in the double-blind studies , 156 entered year 1 of the open extension and 70 patients completed 5 years of finasteride therapy . In both studies prostate volume was reduced from baseline by 30 % , dihydrotestosterone was reduced by 72 % , and the maximum urinary flow rate improved by approximately 1.5 ml/s . Prostate-specific antigen was decreased by approximately 50 % . Finasteride was well tolerated ; approximately 10 % of patients reported sexual adverse experiences during the 5-year study period , which were considered drug related by the investigators . The incidence in reporting sexual adverse experiences did not increase with the increased duration of treatment : findings consistent with previous reports . In summary treatment of BPH with finasteride for 5 years inhibits the progression of the disease with an excellent safety profile and represents a low-risk medical option for the treatment of symptomatic BPH BACKGROUND Finasteride , a 5 alpha-reductase inhibitor , has been shown to have beneficial effects in the treatment of benign prostatic hyperplasia . The long-term safety and efficacy of finasteride in the treatment of benign prostatic hyperplasia was assessed . METHODS In two multicenter , double-blind , placebo-controlled studies ( North American and international ) , patients with symptomatic benign prostatic hyperplasia were r and omly assigned to receive finasteride , 1 or 5 mg , or placebo for 1 year followed by an open-extension study in which all patients were treated with finasteride , 5 mg , regardless of original therapy . Men aged 40 to 80 years , in good physical and mental health , were eligible to enter the study . All patients were to have a maximum urinary flow rate of 15 mL/s or less with a voided volume of 150 mL or more , an enlarged prostate , and symptoms of urinary obstruction . Patients with a prostate-specific antigen level of 40 mg/mL or more or any finding suggestive of prostate cancer were excluded . RESULTS Two hundred ninety-eight patients received finasteride , 5 mg , continuously for 24 months . At the end of 24 months of finasteride therapy , the median prostate volume was reduced by 25 % , and 60 % of patients had a 20 % or greater reduction in prostate volume . Maximum urinary flow rate was improved by at least 2 mL/s , and symptoms were improved by approximately 3.5 points . Decreased libido and ejaculation disorders were the only drug-related adverse experiences reported in more than 1 % of patients . CONCLUSION These studies support the long-term safety and tolerability of finasteride , while demonstrating its continuing clinical efficacy in the treatment of patients with symptomatic benign prostatic hyperplasia The clinical effects of finasteride , a 5 alpha-reductase inhibitor , in patients with benign prostatic hyperplasia ( BPH ) were evaluated in a double-blind , placebo-controlled study . Forty-six patients with symptomatic BPH were r and omly assigned to 2 groups , the finasteride group and the placebo group . The finasteride group received 5 mg of finasteride daily for 6 months . Prostate volume , urinary flow , urinary symptoms , serum prostate-specific antigen ( PSA ) and adverse events were determined before and after treatment . After 6 months of treatment the patients treated with 5 mg of finasteride per day had a 30 % decrease in their total urinary symptom score , a 14 % decrease in prostate volume and a 0.9 ng/dL decrease of PSA . Their maximal urinary flow rate increased by 1.42 mL per second and the mean urinary flow rate increased by 0.64 mL per second . The patients given placebo showed no significant changes in their prostate volume , serum PSA and maximal and mean urinary flow rate . However , the symptom scores in the placebo group also decreased significantly . When compared with the placebo group , those in the finasteride group had significantly lower prostate volume , serum PSA , maximal urinary flow rate and urinary symptoms , but not mean urinary flow rate . The frequency of adverse events was low in both the finasteride and placebo groups . These results show that finasteride may be an effective and safe alternative for the treatment of patients with BPH In 18 of 55 original patients who completed 5 years of treatment with finasteride , significant reductions in prostate size were noted at 1 year and sustained thereafter . Symptom scores in these same patients were significantly improved or stable over the 5 years while maximal urinary flow rates were unchanged . Data from 15 of 18 other patients who dropped out of the study before 5 years showed changes in prostate size , symptom score and flow rates that were similar to those noted in patients treated for 5 years . No side effects were noted in this study except for sexual dysfunction , which occurred in less than 5 % of the patients . With few exceptions , finasteride appears to arrest the process of BPH over a 5 year period as indicated by sustained reductions in prostate size accompanied by either symptomatic improvement or stability in all other patients This study was design ed to determine the efficacy of the 5 alpha-reductase inhibitor finasteride ( Proscar , MK-906 ) in men with reduced urinary flow rates and symptoms of urinary outflow obstruction secondary to benign prostatic hyperplasia . Forty-five men were r and omized to one of three groups receiving either placebo , 1 mg/day or 5 mg/day finasteride for the first 12 months of the study period . At the end of this period all men received 5 mg/day finasteride for a further 2 years . Efficacy was determined by measurement of prostate volume , maximum urinary flow rate , and symptom score using a modified Boyarsky assessment . Prostate volume reduced by 20 and 27 % , respectively , for those on 1 and 5 mg after the first year . At 3 years the volume had reduced by 43 % . This reduction in prostate volume was associated with an improvement in maximum urinary flow rate by 50 % ( 1 mg ) , and 35 % ( 5 mg ) at 1 year , and 36 % at 3 years . The total , obstructive and non-obstructive symptom scores decreased ( improved ) for patients on 1 and 5 mg finasteride , with the total score reducing by 33 % from baseline at year 3 . The results demonstrate that finasteride causes a modest but significant clinical improvement in men with urinary outflow obstruction secondary to benign prostatic hyperplasia PURPOSE We determine the effect of placebo , finasteride , terazosin and a combination of drugs on bother due to symptoms , quality of life and patient perception of improvement , and identify baseline clinical factors that predict clinical response to medical therapy . MATERIAL S AND METHODS A total of 1,229 subjects with clinical benign prostatic hyperplasia ( BPH ) were r and omized to 1 year of placebo , finasteride , terazosin or drug combination . The primary outcome measures were American Urological Association ( AUA ) symptom score and peak flow rate . Relevant secondary outcome measures were symptom problem score , BPH impact score and global rating of improvement . RESULTS Group mean differences in symptom problem and BPH impact scores between the finasteride versus placebo , and terazosin versus combination groups were not statistically or clinical ly significant . Group mean differences in all outcome measures were highly statistically significant between the terazosin and finasteride , and combination and finasteride groups . The percentage of subjects who rated improvement as marked or moderate with placebo , finasteride , terazosin and combination was 39 , 44 , 61 and 65 % , respectively . In the subsets of men in the placebo , finasteride , terazosin and combination groups with prostates greater than 50 cm.3 group mean decrease from baseline in AUA symptom score was -2.5 , -3.6 , -6 and -7 , group mean increase in peak flow rate was 0.6 , 2.7 , 3.6 and 3.7 ml . per second , group mean decrease in symptom problem score was -2.2 , - 1.9 , -3.1 and -4.5 , and group mean decrease in BPH impact score was -0.6 , -0.3 , -1.1 and -1.5 , respectively . A correlational analysis failed to show a significant relationship between baseline prostate volume and treatment response to finasteride . There was a significant but weak relationship between change in AUA symptom score and peak flow rate in the finasteride and combination groups . The symptom responses with terazosin were independent of baseline peak flow rate . CONCLUSIONS In men with clinical BPH  finasteride and placebo are equally effective , while terazosin and combination are significantly more effective . In men with clinical BPH and large prostates the advantage of finasteride over placebo in terms of symptom reduction , impact on bother due to symptoms and quality of life is small at best , while the advantage of terazosin and combination over finasteride and placebo is highly significant . Baseline prostate volume was not a predictor of response to finasteride in the overall study population . On the basis of our results alpha1 blockers , such as terazosin , should be first line medical treatment for BPH PURPOSE We sought to quantify prostate tissue changes induced by finasteride and to identify a predictor of finasteride response in men with symptomatic benign prostatic hyperplasia ( BPH ) via a r and omized , placebo controlled , double-blind clinical trial . MATERIAL S AND METHODS Men with symptomatic BPH ( 52 to 78 years old ) were r and omly assigned to 6 months of treatment with finasteride ( 26 ) or placebo ( 15 ) . Outcome measures were clinical ( urinary symptom score and flow rate ) , chemical ( serum prostate specific antigen and dihydrotestosterone levels ) , volumetric ( transrectal ultrasound , and magnetic resonance imaging for whole and zonal prostate volumes ) and histological ( morphometry of prostate sextant biopsies , separated into inner and outer gl and segments , to measure the percent epithelium , stroma and gl and ular lumen ) . RESULTS In the finasteride group we found a suggestion of decreasing symptom scores and increasing flow rates ( not significant ) with significant decreases ( p < 0.01 ) in prostate specific antigen ( 48 % ) , dihydrotestosterone ( 74 % ) and prostate volume ( 21 % ) . Finasteride treatment induced a 55 % decrease in inner gl and epithelium ( p < 0.01 ) with little effect on stroma or lumina . We also found a linear correlation between pretreatment inner gl and epithelial content and prostate volume decrease induced by the drug ( tau = 0.58 , p = 0.01 ) . CONCLUSIONS Finasteride treatment results in a major suppression of prostate epithelium , which is most pronounced in the inner gl and . Moreover , a finasteride induced prostate volume decrease was predictable by quantification of epithelial tissues of the inner gl and . These data lend additional support to the emerging concept of transition zone primacy in symptomatic BPH Urodynamic effects of the 5-alpha-reductase inhibitor , finasteride , were studied in the treatment of patients with bladder outlet obstruction due to benign prostatic hyperplasia ( BPH ) . A total of 36 patients was r and omly assigned in a double-bind manner to receive either 5 mg . finasteride daily ( 19 ) or placebo ( 17 ) for 6 months . The possible relief of bladder outlet obstruction was monitored with uroflowmetry and repeated urodynamics . The mean flow rate , detrusor opening pressure , detrusor pressure at maximum flow and maximum detrusor pressure improved significantly in the patients treated with finasteride . There were no significant differences in the improvement of symptom score or peak flow rate , or in the reduction of residual urine between the finasteride and placebo groups . The treatment result ed in 30 % average decrease in prostatic size and 46 % decrease in prostate specific antigen concentration . The efficacy of finasteride in relief of bladder outlet obstruction caused by BPH seems to be of the same degree as that achieved by chemical castration therapy but without any significant side effects . There were wide variations among BPH patient response to finasteride treatment . Further studies are needed to define the responders who benefit from this treatment OBJECTIVES To compare the efficacy and safety of finasteride 5 mg in older ( 65 years old or older ) versus younger ( 45 to younger than 65 years old ) men with benign prostatic hyperplasia ( BPH ) . METHODS The Proscar Long-Term Efficacy and Safety Study ( PLESS ) was a 4-year , r and omized , double-blind , placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men 45 to 78 years old with symptomatic BPH , enlarged prostates , and no evidence of prostate cancer . The endpoints included urinary symptoms , prostate volume , occurrence of acute urinary retention and /or BPH-related surgery , and safety . RESULTS In both age cohorts , finasteride treatment led to a 51 % reduction ( P < 0.001 ) in the relative risk for acute urinary retention and /or BPH-related surgery , a significant ( P < 0.001 ) and durable improvement in symptom score , and a significant ( P < 0.001 ) and sustained reduction in prostate volume . Within each age cohort , no significant differences were found between the placebo and finasteride-treated patients in the incidence of cardiovascular adverse events . Significant differences were evident between the placebo and finasteride groups in the incidence of the typical , known , drug-related adverse events , but no specific differences were associated with age . No drug interactions of clinical importance were observed in the finasteride-treated patients . CONCLUSIONS The present analysis from PLESS demonstrates that in both older ( 65 years old or older ) and younger men with symptomatic BPH and enlarged prostates , finasteride is highly effective in improving symptoms and reducing prostate volume in many men and in reducing the risk of acute urinary retention and BPH-related surgery . In addition , the safety profile of finasteride in both older and younger men is similar and no drug interactions of clinical importance were observed
MAIN RESULTS Finasteride consistently improved urinary symptom scores more than placebo in trials of > 1 year duration , and significantly lowered the risk of BPH progression ( acute urinary retention , risk of surgical intervention , ≥ 4 point increase in the AUASI/IPSS ) .
In comparison to alpha-blocker monotherapy , finasteride was less effective than either doxazosin or terazosin , but equally effective compared to tamsulosin .
Both doxazosin and terazosin were significantly more likely than finasteride to improve peak urine flow and nocturia , versus finasteride .
Versus tamsulosin , peak urine flow and QoL improved equally well versus finasteride .
However , finasteride was associated with a lower risk of surgical intervention compared to doxazosin , but not to terazosin , while finasteride and doxazosin were no different for risk of acute urinary retention .
Finasteride + doxazosin and doxazosin monotherapy  improved urinary symptoms equally well ( ≥ 4 point improvement).For finasteride , there was an increased risk of ejaculation disorder , impotence , and lowered libido , versus placebo .
Versus doxazosin , finasteride had a lower risk of asthenia , dizziness , and postural hypotension , and versus terazosin , finasteride had a significant , lower risk of asthenia , dizziness , and postural hypotension .
Finasteride improves long-term urinary symptoms versus placebo , but is less effective than doxazosin .
Long-term combination therapy with alpha blockers ( doxazosin , terazosin ) improves symptoms significantly better than finasteride monotherapy .
Finasteride + doxazosin improves symptoms equally - and clinical ly - to doxazosin alone .
Finasteride + doxazosin versus doxazosin  improves scores equally for short and long term .
Drug-related adverse effects for finasteride are rare ; nevertheless , men  taking  finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder , versus placebo .
Versus doxazosin , which has higher rates of dizziness , postural hypotension , and asthenia , men taking finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder .
Finasteride significantly reduces asthenia , postural hypotension , and dizziness versus terazosin .
Finasteride significantly lowers the risk of asthenia , dizziness , ejaculation disorder , and postural hypotension , versus finasteride + terazosin
BACKGROUND Benign prostatic hyperplasia ( BPH ) , a non-malignant enlargement of the prostate in aging men , can cause bothersome urinary symptoms ( intermittency , weak stream , straining , urgency , frequency , incomplete emptying ) .
Finasteride , a five-alpha reductase inhibitor ( 5ARI ) , blocks the conversion of testosterone to dihydrotestosterone , reduces prostate size , and is commonly used to treat symptoms associated with BPH .
OBJECTIVES To compare the clinical effectiveness and harms of finasteride versus placebo and active controls in the treatment of lower urinary tract symptoms ( LUTS ) .