5 Alpha-reductase inhibitors: whatʼs new?

As of 2003, medical therapy had become the primary treatment for men with symptomatic benign prostatic hyperplasia (BPH), with finasteride being the sole 5 alpha-reductase inhibitor available for the past decade, targeting the type 2 isoenzyme. The review discussed the introduction of dutasteride, a new drug capable of inhibiting both type 1 and type 2 isoenzymes, which showed greater and faster dihydrotestosterone suppression than finasteride. Dutasteride was reported to be at least as effective as finasteride in improving symptoms, flow rates, and reducing the risk of acute urinary retention or the need for BPH-related surgery. The Medical Therapy of Prostatic Symptoms trial indicated that combination therapy was superior to monotherapy, a finding not seen in shorter trials, and confirmed the ability of 5 alpha-reductase inhibitors to prevent disease progression. The review also noted emerging roles for these inhibitors, such as managing BPH-related haematuria and investigating their potential as chemopreventive agents for prostate cancer. The study suggested that the roles of 5 alpha-reductase inhibitors in treating BPH could expand, especially with the advent of dual isoenzyme inhibition.