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Finasteride for BPH 2

 

Clinical bottom line

Finasteride reduced symptoms in older and younger men, and white, black and hispanic men. Finasteride cut serum PSA values by half.


Reference

CA Byrnes et al. Combined analysis of two multicenter studies of finasteride 5 mg in the treatment of symptomatic benign prostatic hyperplasia. Prostate Cancer and Prostate Diseases 1997 1: 26-31.

Review

This is not a true review, but combines data from two large trials in men older than 45 years with moderate or severe urinary symptoms and with PSA values of 10 ng/mL or less. Both trials were randomised, but examination of the original studies would be required to answer questions about study quality. Trial validity is discussed in detail.

An attempt was made on an individual patient basis to examine the efficacy of finasteride 5 mg by age and race.

Results

In the two trials, 3,557 men were randomised to placebo and 1,175 to placebo. About 50% were over 65 years. Trial duration was 12 months. By 12 months 53% of men on finasteride experienced a global improvement compared with 43% of men receiving placebo (statistically significant at the 1% level).

Finasteride was equally effective in older men (65 years or more) and younger men (less than 65 years). Black and hispanic men fared no differently than did white men.

Adverse events occurring more frequently with finasteride were predominantly sexual (erectile dysfunction, decreased libido, ejaculation disorder), though few men withdrew because of this.

Finaseride reduced serum PSA values by almost exactly 50% in white, black and hispanic men.

Comment

This is a useful exercise, in that it included a large population of men, and showed that age and ethnic origin made no difference to the efficacy of finasteride. Noting that finasteride reduces serum PSA levels by 50% is an important observation when interpreting any PSA measurements made in men taking finasteride.