A Risk-Benefit Assessment of Treatment with Finasteride in Benign Prostatic Hyperplasia

    January 1998 in “ Drug safety ”
    Peter Ekman
    TLDR Finasteride helps reduce prostate size and symptoms in BPH but is less effective than terazosin and works best for larger prostates.
    The document assessed the risk-benefit profile of finasteride for treating benign prostatic hyperplasia (BPH). Finasteride reduced serum 5α-DHT levels by 80%, leading to a 20-25% reduction in prostate size and a 30% improvement in prostatic symptoms over 6 months, with effects lasting up to 6 years. However, it was less effective than the α-blocker terazosin in a double-blind study and showed significant benefits only in patients with prostate glands larger than 40ml. Finasteride was well tolerated, with a 3-4% incidence of impotence and some cases of decreased ejaculatory volume and gynaecomastia. Early intervention with finasteride could reduce the need for surgical procedures over a 2-year period.
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