5-Alpha-reductase inhibitors in diseases of the prostate

To summarize the history of the use of 5-alpha-reductase inhibitors in the treatment of urologic diseases and discuss the current practices and indications for therapy.

5-Alpha-reductase inhibitors (5-ARIs) are indicated in the treatment of benign prostatic hyperplasia (BPH) with obstructive urinary symptoms to reduce symptoms, reduce the risk of acute urinary retention, and reduce the risk of needing surgical management for this condition. These drugs have also been employed in the treatment of recurrent and refractory hematuria of prostatic origin because of their effect on the androgen-mediated angiogenic pathways in the prostate. Data support the use of 5-ARIs for this indication, though this is off-label use. There is no role for the use of 5-ARIs in primary prostate cancer chemoprevention and they may increase the risk of developing high-grade prostate cancer. Current investigations are underway to determine the efficacy of 5-ARIs in the secondary treatment of localized prostate cancer as adjunctive therapy, which may decrease the likelihood of prostate cancer progression and increase the likelihood that patients will remain on active surveillance.

5-ARIs have significantly impacted the medical treatment of urologic disease, in particular BPH, and prostatic hematuria. Their use in the secondary treatment of prostate cancer is currently under investigation.