The Clinical Applications of Five-Alpha Reductase Inhibitors

    April 2021 in “ Canadian Journal of Urology ”
    Kevin R. Loughlin
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    TLDR Five-alpha reductase inhibitors, like finasteride and dutasteride, can treat enlarged prostates, improve urination, reduce need for prostate surgery, and lower the risk of prostate cancer, but may increase the risk of higher grade prostate cancer. They can also treat male pattern baldness.
    Five-alpha reductase inhibitors (5-ARIs), specifically finasteride and dutasteride, have been proven effective in treating benign prostatic hyperplasia, improving voiding symptoms, and reducing the risk of urinary retention and the need for prostate surgery. The Prostate Long Term Efficacy and Safety Study (PLESS) showed that finasteride resulted in a 22% increase in maximum flow rate and a 19% decrease in prostate volume, significantly reducing the risk of surgery and urinary retention over a 4-year period. Similar results were found with dutasteride. The Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) studies showed that 5-ARIs can reduce the risk of prostate cancer, although they may increase the risk of higher grade prostate cancer. Additionally, a lower dose of finasteride has been effective in treating male pattern baldness.
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