Editing Benign prostatic hyperplasia (section)

==== 5α-reductase inhibitors ====

The 5α-reductase inhibitors [[finasteride]] and [[dutasteride]] may also be used in people with BPH.<ref name="Blankstein2016">{{cite journal | vauthors = Blankstein U, Van Asseldonk B, Elterman DS | title = BPH update: medical versus interventional management | journal = The Canadian Journal of Urology | volume = 23 | issue = Suppl 1 | pages = 10–15 | date = February 2016 | pmid = 26924590 | url = http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | url-status = live | archive-url = https://web.archive.org/web/20160807134146/http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | archive-date = 7 August 2016 }}</ref> These medications inhibit the [[5α-reductase]] enzyme, which, in turn, inhibits the production of [[Dihydrotestosterone|DHT]], a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years.<ref name="Roehrborn2004">{{cite journal | vauthors = Roehrborn CG, Bruskewitz R, Nickel JC, McConnell JD, Saltzman B, Gittelman MC, Malek GH, Gottesman JE, Suryawanshi S, Drisko J, Meehan A, Waldstreicher J | title = Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia | journal = The Journal of Urology | volume = 171 | issue = 3 | pages = 1194–1198 | date = March 2004 | pmid = 14767299 | doi = 10.1097/01.ju.0000112918.74410.94 | collaboration = Proscar Long-Term Efficacy Safety Study Group }}</ref> When used together with alpha-blockers, no benefit was reported in short-term trials, but in a longer-term study (3–4 years) there was a greater reduction in BPH progression to acute urinary retention and surgery than with either agent alone, especially in people with more severe symptoms and larger prostates.<ref>{{cite journal | vauthors = Roehrborn CG, Barkin J, Tubaro A, Emberton M, Wilson TH, Brotherton BJ, Castro R | title = Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study | journal = BJU International | volume = 113 | issue = 4 | pages = 623–635 | date = April 2014 | pmid = 24127818 | doi = 10.1111/bju.12500 | s2cid = 38243275 }}</ref><ref name="ReferenceB">{{cite journal | vauthors = Greco KA, McVary KT | title = The role of combination medical therapy in benign prostatic hyperplasia | journal = International Journal of Impotence Research | volume = 20  | issue = Suppl 3 | pages = S33–S43 | date = December 2008 | pmid = 19002123 | doi = 10.1038/ijir.2008.51 | doi-access = free }}</ref><ref name="pmid16406915">{{cite journal | vauthors = Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR, Kusek JW, Nyberg LM | title = Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater | journal = The Journal of Urology | volume = 175 | issue = 1 | pages = 217–20; discussion 220–1 | date = January 2006 | pmid = 16406915 | doi = 10.1016/S0022-5347(05)00041-8 | collaboration = Medical Therapy of Prostatic Symptoms (MTOPS) Research Group }}</ref> Other trials have confirmed reductions in symptoms, within 6 months in one trial, an effect that was maintained after withdrawal of the alpha blocker.<ref name="ReferenceB" /><ref>{{cite journal | vauthors = Barkin J, Guimarães M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB | title = Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride | journal = European Urology | volume = 44 | issue = 4 | pages = 461–466 | date = October 2003 | pmid = 14499682 | doi = 10.1016/s0302-2838(03)00367-1 }}</ref> Side effects include decreased [[libido]] and ejaculatory or erectile dysfunction.<ref name = Gormley>{{cite journal | vauthors = Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS | title = The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group | journal = The New England Journal of Medicine | volume = 327 | issue = 17 | pages = 1185–1191 | date = October 1992 | pmid = 1383816 | doi = 10.1056/NEJM199210223271701 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gacci M, Ficarra V, Sebastianelli A, Corona G, Serni S, Shariat SF, Maggi M, Zattoni F, Carini M, Novara G | title = Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis | journal = The Journal of Sexual Medicine | volume = 11 | issue = 6 | pages = 1554–1566 | date = June 2014 | pmid = 24708055 | doi = 10.1111/jsm.12525 }}</ref> The 5α-reductase inhibitors are contraindicated in pregnant women because of their [[teratogenicity]] due to interference with fetal testosterone metabolism, and as a precaution, pregnant women should not handle crushed or broken tablets.<ref>{{cite web | vauthors = Deters L |title = Benign Prostatic Hypertrophy Treatment & Management |url = http://emedicine.medscape.com/article/437359-treatment |website = Medscape |access-date = 14 November 2015 |url-status = live |archive-url = https://web.archive.org/web/20151030062812/http://emedicine.medscape.com/article/437359-treatment |archive-date = 30 October 2015}}</ref>
[[File:NHS-medicines-effectiveness.png|none|thumb|650x650px|The effectiveness of alpha-blockers and 5-ARIs, and a combination of the two, versus placebo pills, in improving symptoms of an enlarged prostate.<ref name="McConnell_2003">{{cite journal | vauthors = McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA | title = The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 349 | issue = 25 | pages = 2387–2398 | date = December 2003 | pmid = 14681504 | doi = 10.1056/NEJMoa030656 }}</ref><ref name="Roehrborn_2010">{{cite journal | vauthors = Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F | title = The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study | journal = European Urology | volume = 57 | issue = 1 | pages = 123–131 | date = January 2010 | pmid = 19825505 | doi = 10.1016/j.eururo.2009.09.035 }}</ref><ref name="Kaplan_2006">{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 }}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-medicines-sideeffects.png|none|thumb|676x676px|The frequency of side effects from alpha-blockers and 5-ARIs.<ref name="McConnell_2003" /><ref name="Roehrborn_2010" /><ref name="Kaplan_2006" /><ref>{{cite journal | vauthors = van Dijk MM, de la Rosette JJ, Michel MC | title = Effects of alpha(1)-adrenoceptor antagonists on male sexual function | journal = Drugs | volume = 66 | issue = 3 | pages = 287–301 | date = 2006-02-01 | pmid = 16526818 | doi = 10.2165/00003495-200666030-00002 }}</ref><ref>{{cite journal | vauthors = Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G | title = [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia] | journal = Progres en Urologie | volume = 25 | issue = 3 | pages = 115–127 | date = March 2015 | pmid = 25605342 | doi = 10.1016/j.purol.2014.12.003 }}</ref><ref>{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]