Endocrine therapy for benign prostatic hyperplasia in the 90's

Area of Science:

• Endocrinology
• Urology
• Pharmacology

Background:

• Benign prostatic hyperplasia (BPH) has a long history of endocrine therapy, with early castration methods abandoned for surgical techniques.
• Prostate cells are highly sensitive to 5 alpha-dihydrotestosterone (DHT), an active androgen derived from testosterone.
• Estrogen's role in BPH development suggests potential benefits from blocking aromatization.

Purpose of the Study:

• To evaluate the efficacy of 5 alpha-reductase inhibitors in treating benign prostatic hyperplasia.
• To assess the long-term effects of finasteride on prostate size, urinary flow, and symptoms.
• To investigate the potential of aromatase inhibitors in managing BPH.

Main Methods:

• Clinical trials involving finasteride, a 5 alpha-reductase inhibitor, were conducted.
• Double-blind, randomized, placebo-controlled studies assessed finasteride's impact on BPH progression over 2-3 years.
• Phase II and placebo-controlled studies examined the effects of aromatase inhibitors.

Main Results:

• Finasteride significantly reduced prostate size, improved urinary flow, and decreased symptom scores compared to placebo.
• The therapeutic effects of finasteride were sustained for at least 3 years.
• Aromatase inhibitors did not demonstrate superior efficacy over placebo in controlled studies.

Conclusions:

• Finasteride is an effective endocrine therapy for benign prostatic hyperplasia, halting disease progression.
• The 5 alpha-reductase inhibitor finasteride offers sustained improvement in BPH symptoms and urinary flow.
• Current evidence does not support the use of aromatase inhibitors for BPH management.