Clinical Medicine Reviews in Oncology

Treatment of benign prostatic hyperplasia (BPH) has evolved over that last 10 years consequent to the results of several important clinical trials. Although the primary concern for patients is their symptoms, we as urologists are further concerned about the progression of disease and complications of the disease. Two classes of medications, alpha blockers and 5 alpha reductase inhibitors (5ARI), have shown excellent results for treatment of symptoms and improvement of peak urine flow. Either medication alone has benefit, however, the combination of these medications seems to have more benefit than either alone as best demonstrated by 2 major clinical trials. Though combination therapy is overall superior, evidence has shown that dutasteride as monotherapy has continually improving effects on BPH symtoms and progression of disease beyond 2 years of treatment. Given the cost and side effects of a dual treatment regimen coupled with evidence for continued symptom relief when alpha blockers are removed from combination with dutasteride, there is good evidence for use of dutasteride as long-term monotherapy. Although the evidence thus far favours dutasteride over finasteride in symptom relief and peak urine flow in BPH patients, the difference in selection criteria between finasteride and dutasteride trials creates difficulty in deciding superiority of one over the other. The evidence for dutasteride as monotherapy for BPH is reviewed herein with some comparisons to finasteride.