Editorial Comment

The MTOPS trial investigated the long-term effects of doxazosin, finasteride, and their combination on BPH progression in men with moderate to severe LUTS. It found that combination therapy was more effective in men with higher PSA levels and larger prostate volumes, with a number needed to treat of 4.9 and 4.7 for specific subgroups compared to 8.4 for the entire cohort. Further analysis suggested benefits for men with prostate volumes of 25 to 40 ml, but the results were considered exploratory due to potential statistical chance from multiple subgroup analyses. The study highlighted a 50% relative decrease in progression, but the absolute decrease was minimal, raising questions about the cost-effectiveness of combination therapy given its low impact on clinical progression rates and potential adverse effects.