Comparative Effectiveness and Safety of Finasteride and Dutasteride in the Treatment of Benign Prostatic Hyperplasia:...

Background and Objectives: Benign prostatic hyperplasia (BPH) is one of the most common chronic conditions in older men, significantly impairing quality of life (QoL) by causing lower urinary tract symptoms (LUTSs). 5-alpha-reductase inhibitors (5-ARIs), including finasteride and dutasteride, remain a cornerstone of pharmacotherapy for BPH; however, comparative real-world data remain limited. The aim of this retrospective clinical study was to compare the therapeutic efficacy and safety of finasteride and dutasteride in patients with BPH. Materials and Methods: A total of 401 patients with BPH were retrospectively analyzed: 162 received finasteride and 239 received dutasteride. Clinical parameters, including the International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, and International Index of Erectile Function-5 (IIEF-5) score; urodynamic outcomes, including maximum urinary flow rate (Qmax), average flow rate (Qave), and post-void residual urine volume (PVR); and biochemical markers, including prostate-specific antigen (PSA) and serum creatinine levels, were evaluated at baseline and after at least 6 months of continuous therapy. Statistical significance was defined as p < 0.05. Results: Both treatment groups demonstrated significant within-group improvements in LUTS severity and urodynamic outcomes (p < 0.001 for IPSS, Qmax, and QoL). Compared with finasteride, dutasteride achieved greater reductions in prostate volume (-26.3% vs. -18.1%, p = 0.008) and PSA levels (-43.7% vs. -32.5%, p = 0.014), as well as a slightly greater improvement in IPSS (-6.8 ± 3.9 vs. -5.9 ± 3.6, p = 0.042). Both drugs showed comparable effects on erectile function, as indicated by similar IIEF-5 score changes (Δ = -0.9 ± 2.8 vs. -0.7 ± 2.5, p = 0.51), confirming that neither agent demonstrated a clinically meaningful difference in sexual outcomes. Renal function parameters remained stable in both cohorts. Multivariate analysis identified higher BMI and older age as independent predictors of lower IIEF-5 scores in the finasteride group, while baseline prostate volume was the principal determinant of response in the dutasteride group. Conclusions: Both 5-ARIs effectively reduced LUTS severity and improved urodynamic parameters in men with BPH. Dutasteride demonstrated superior reductions in prostate volume and PSA, while both agents had comparable effects on sexual and renal function. These findings provide real-world evidence supporting the individualization of 5-ARI therapy according to patient-specific clinical characteristics.