Drug Therapy of BPH: Is Combination Therapy with 5α-Reductase Inhibitors and α-Receptor Blockers Useful?

The document discussed the use of 5α-reductase inhibitors and α1-receptor blockers as primary drug therapies for symptomatic benign prostatic hyperplasia (BPH). It evaluated the potential benefits of combining these therapies through several placebo-controlled studies, including the VA, ALFIN, PREDICT, and MTOPS studies. Results showed a statistically significant benefit for groups receiving α1-receptor blockers and combination therapy compared to placebo and finasteride monotherapy in terms of symptom scores and peak urine flow rates. However, no significant advantage was found for combination therapy over α1-receptor blockers alone. The studies suggested that for patients with prostate volumes up to 40–45 ml, adding a 5α-reductase inhibitor to α1-receptor blocker therapy was not beneficial. In contrast, for patients with prostate volumes over 60 ml, combination therapy might be more effective.