Focus on Finasteride: Efficacy, Mechanisms, and Recommendations for Clinical Use

The article discusses the efficacy and clinical recommendations for the use of finasteride, a selective 5α-reductase type 2 inhibitor, in treating benign prostatic hyperplasia (BPH), a common condition in older men. Finasteride effectively reduces prostate volume, improves urinary flow, and decreases the risk of acute urinary retention and surgical intervention by lowering intraprostatic dihydrotestosterone levels. Studies like PLESS and MTOPS support its long-term efficacy and safety. Additionally, finasteride helps reduce perioperative bleeding in transurethral resection of the prostate (TURP) and treats BPH-related hematuria due to its antiangiogenic and antiproliferative effects. While its role in prostate cancer chemoprevention is debated, meta-analyses suggest it lowers the incidence of low-grade tumors without increasing high-grade forms. Finasteride offers therapeutic advantages over α-blockers for certain patients, such as those sensitive to hypotension or concerned about sexual side effects. Combined therapy with α-blockers enhances symptom control and reduces progression risk, though finasteride monotherapy is effective for long-term maintenance. Its favorable safety profile and clinical versatility make finasteride a key therapeutic option for personalized BPH management.