Efficacy and Safety of 5 Alpha-Reductase Inhibitor Monotherapy in Patients with Benign Prostatic Hyperplasia: A Meta-Analysis

The meta-analysis conducted in 2018 analyzed the effectiveness and safety of 5 alpha-reductase inhibitors (5ARIs) in treating benign prostatic hyperplasia (BPH). It included 42 studies with 23,395 patients, revealing that 5ARIs significantly improved prostate-specific antigen (PSA) levels, prostate volume (PV), International Prostate Symptom Score (IPSS), and maximum urinary flow rate (Qmax) compared to placebo. However, the study also found that the effect size of these improvements was small and showed a declining trend over the years. Additionally, 5ARI treatment was linked to a higher incidence of adverse sexual events such as decreased libido, ejaculatory disorder, gynecomastia, and impotence. The study concluded that while 5ARIs can be beneficial for BPH, their use should be carefully considered due to the small improvement in symptoms and the high risk of adverse events. The authors suggested that combination treatments might be superior to 5ARI monotherapy and called for further research to reassess the clinical efficacy of 5ARIs.