The Impact of Medical Therapy on Bother Due to Symptoms, Quality of Life and Global Outcome, and Factors Predicting Response

Abstract

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.

Management of Symptomatic BPH in the US: Who Is Treated and How?

“…In the nationwide survey, most of the PCPs also mainly prescribed α 1 -adrenoceptor antagonists whereas finasteride was used more rarely [10]. A total of 20% of PCPs were applying combination therapy despite the fact that several studies have indicated that combination therapy is no more effective than an α 1 -adrenoceptor antagonist alone [12, 13, 14]. This is however due to the fact that the survey took place in 1995 before the results of the combination trials were available.…”

Who Should Be Treated and How? Evidence-Based Medicine in Symptomatic BPH

“…In addition, it is an option in patients with more severe symptoms who are unable or unwilling to undergo surgery and in those awaiting surgery [118]. However, the onset of action is slow and results from three direct comparative trials of up to 12 months duration showed that finasteride monotherapy was not superior to placebo and clearly less effective compared to α 1 -blocker monotherapy or combination therapy in reducing symptom scores and improving maximum urinary flow rates [119, 120, 121], irrespective of prostate size [119]. …”

α₁-Blocker Therapy for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: What Are the Relevant Differences in Randomised Controlled Trials?

“…In contrast to finasteride [70], there is no limitation to efficacy depending on prostate size [71](as confirmed by uncontrolled observations [72]); additionally, efficacy does not relate to baseline PSA [34]. Recently, magnetic resonance imaging (MRI) estimating the area density of smooth muscle cells in the prostate was shown to help to predict Q max -responsiveness to α 1 -blockade [73].…”