The National Institutes of Health-funded Medical Therapy of Prostate Symptoms trial, which recently concluded, compared treatment with doxazosin, finasteride, and combination therapy (46). Both doxazosin-treated and finasteride-treated individuals had equivalent reductions in risk of BPH progression. Combination treatment with doxazosin and finasteride was more effective than monotherapy with either agent in preventing progression of clinical BPH. All treatments reduced the risk of acute urinary retention, with doxazosin yielding a short-term risk reduction and finasteride and combination therapy resulting in long-term risk reduction. Regarding AUA symptom score and maximal urinary flow rate, combination therapy was more effective than either agent alone. In summary, combination treatment with doxazosin and finasteride was more effective than either alone in producing improvements in AUA symptom score and maximal voiding pressure, whereas finasteride monotherapy and combination therapy both reduced the long-term risks of acute urinary retention and surgical intervention.
Recently, combination, type 1 and type 2,5a-reductase inhibitor therapy, dutasteride, has been approved for use. In initial pharmacoki-netic studies, dutasteride was found to be three times more potent than finasteride in blocking the type 2,5a-reductase enzyme. Nearly full blockade of both isoenzymes is achieved at 10-mg doses (47). At this time, it is unclear whether dual blockade offers increased efficacy in treatment of BPH.
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