5ARIs are recommended for men who have moderate-to-severe lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia. Studies have confirmed the utility of combining 5ARIs with alpha-blockers; the MTOPS study showed that risk of overall clinical progression was significantly reduced after 4.5 years with combination therapy (finasteride/doxazosin) in comparison with either monotherapy, while the ongoing CombAT trial (dutasteride/tamsulosin) has for the first times hown benefit in improving symptoms for combination therapy over monotherapies within 12 months of treatment. Data also suggest roles for 5ARIs in prostate cancer. Several studies indicate that treatment with a 5ARI improves the performance of PSA testing for identifying men with prostate cancer, while the PCPT showed a significant reduction in the risk of developing prostate cancer with finasteride. However, widespread use of finasteride in this setting has been tempered by an apparent increase in high-grade disease observed in the study. The ongoing REDUCE study will provide further insight into prostate cancer prevention with 5ARIs. 5ARI-containing regimens may have utility as less aggressive treatment options for patients who only have rising PSA after definitive local therapy, and in patients with disease resistant to androgen deprivation therapy who have PSA progression. Current evidence therefore shows that 5ARIs are effective in treating LUTS/BPE and preventing disease progression, and may also have a role in the prevention of prostate cancer. The overlap between BPE and prostate cancer may allow a more unified approach to managing these conditions, with 5ARIs having a central role.

Benign prostatic enlargement, Benign prostatic hyperplasia, Dutasteride, Finasteride, Prostate cancer, aged, aging, alpha adrenergic receptor blocking agent, androgen deprivation therapy, androstanolone, antiandrogen, article, azasteroid, bicalutamide, blood, brachytherapy, cancer combination chemotherapy, cancer diagnosis, cancer growth, cancer risk, castration, clinical trial, development and aging, digital rectal examination, disease course, doxazosin, drug antagonism, drug efficacy, dutasteride, ejaculation disorder, enzyme inhibitor, erectile dysfunction, finasteride, gonadorelin agonist, growth, human, ketoconazole, libido disorder, lower urinary tract symptom, male, middle aged, monotherapy, pathology, phase 3 clinical trial, placebo, practice guideline, priority journal, prostate, prostate biopsy, prostate cancer, prostate disease, prostate hypertrophy, prostate specific antigen, prostate tumor, prostatectomy, review, risk reduction, steroid 5alpha reductase, steroid 5alpha reductase inhibitor, sulfonamide, tamsulosin, testosterone, treatment outcome, treatment planning, urinary tract infection
dx.doi.org/10.1002/pros.20939, hdl.handle.net/1765/16294
The Prostate
Erasmus MC: University Medical Center Rotterdam

Montorsi, F, Desgrandchamps, F, Alcaraz, A, Hammerer, P, Schröder, F.H, & Castro, R. (2009). A broader role for 5ARIs in prostate disease? Existing evidence and emerging benefits. The Prostate, 69(8), 895–907. doi:10.1002/pros.20939