Current status of 5α-reductase inhibitors in the management of lower urinary tract symptoms and BPH

PURPOSE: Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS in terms of symptoms and urinary flow, but also to identify those patients at a risk of unfavorable disease progression and to optimize their management. This article reviews the current status of therapy with 5α-reductase inhibitors (5ARIs), namely fiasteride and dutasteride, for men with LUTS and BPH. METHOD: Data from key randomized controlled trials (Oxford level 1b) on the use of 5ARIs are analyzed. RESULTS: The efficacy of 5ARIs either as monotherapy or in combination with α(1)-adrenoceptor antagonists in the management of LUTS and the impact of monotherapy and combined therapy on BPH progression are discussed. Further promises, including the withdrawal of the α-blocker from the combined medical treatment and the potential clinical implications from the use of 5ARIs for prostate cancer chemoprevention in patients receiving 5ARIs for symptomatic BPH are highlighted. CONCLUSIONS: Current evidence shows that 5ARIs are effective in treating LUTS and preventing disease progression and represent a recommended option in treatment guidelines for men who have moderate to severe LUTS and enlarged prostates.