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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