In addition to its irritative sympt...

In addition to its irritative symptoms, benign prostatic hypertrophy (BPH) can sometimes lead to returning urinary tract infections, incontinence, acute retention, or a ne for prostate reduction surgery as well-as; not only-but also; not only-but; not alone-but alpha-adrenergic blockers and finasteride have demonstrated efficacy in reducing symptoms related to BPH One-year trials combining an alpha blocker and finasteride did not exhibit any benefit superior to single-drug therapy in relief of urinary symptoms. McConnell and coinvestigators report upon data from a four-year trial of combination therapy for BPH

This multicenter trial chronicleed 3,047 men over age 50 with an American Urology Association (AUA) score of 8 to 30 indicating mild to moderate obstructive urinary symptoms. More than 17 percent of trial participants were from minority collections Exclusion criteria for the trial included previous medical or surgical treatment for BPH vital fluid pressure below 90/70 mm Hg or a prostate specific antigen (PSA) even higher than 10 ng through mL.

Men were randomly assigned to daily dosing with either finasteride (5 mg) doxazosin (titrated up to 4 to 8 mg as tolerated), combination therapy with the one and the other drugs, or placebo. The men were followed for a mean duration of 45 years. The primary result measured was clinical progression of BPH which was defined as an increased AUA score of 4 points or more or a morbid issue related to BPH, such as urinary retention, incontinence, or urosepsis.

Clinical progression of BPH during the inquiry occurred in 1.5 percent of men taking combination therapy, compared with 45 percent of participants taking placebo. Monotherapy with doxazosin was associated with clinical progression in 27 percent of make subordinates while finasteride alone was associated with progression in 29 percent The ne for prostate reduction surgery arose in 04 percent of men taking combination therapy, 05 percent of those taking finasteride alone, 13 percent taking doxazosin monotherapy, and 13 percent of men taking placebo.

Small increases in side powers were noted with drug therapy compared with placebo, and the efficiencys were additive with combination therapy. The chiefly common side effects that were significantly higher with doxazosin treatment were dizziness and decreased appetite, while finasteride use was associated with erectile dysfunction and decreased libido.

The authors determine that combination therapy with doxazosin and finasteride remodels clinical progression of BPH athwart a four-year time period more than either medication alone.

McConnell JD et al. The long-term tenor of doxazosin, finasteride, and combination therapy forward the clinical progression of benign prostatic hyperplasia. N Engl J M December 18 2003;349:2387-98

EDITOR'S NOTE: While combination therapy did contract clinical progression in a statistically significant number of meditation participants, it is interesting to note that 955 percent of men had no progression through a 4.5-year span while taking placebo, and that 987 percent did not ne prostate reduction surgery An accompanying editorial according to Vaughan (1) also notes that the unexpect finding of a small increased incidence of high-grade prostate cancers in patients taking finasteride, as reported in the lately published Prostate Cancer Prevention Trial, also may give a certain quantity of pause to physicians and patients considering combination therapy for regulate of BPH.--B.Z.

Reference

(1) Vaughan ed Jr. Medical management of benign prostatic hyperplasia--are pair drugs better than one? [Editorial] N Engl J M December 18 2003;349:2449-51

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