This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .
Effect of dutasteride on the risk of prostate cancer.
BACKGROUND We conducted a study to determine whether dutasteride reduces the risk of incident prostate cancer , as detected on biopsy , among men who are at increased risk for the disease . METHODS In this 4-year , multicenter , r and omized , double-blind , placebo-controlled , parallel-group study , we compared dutasteride , at a dose of 0.5 mg daily , with placebo .  Men were eligible for inclusion in the study if they were 50 to 75 years of age , had a prostate-specific antigen ( PSA ) level of 2.5 to 10.0 ng per milliliter , and had had one negative prostate biopsy ( 6 to 12 cores ) within 6 months before enrollment . Subjects underwent a 10-core transrectal ultrasound-guided biopsy at 2 and 4 years . RESULTS Among 6729 men who underwent a biopsy or prostate surgery , cancer was detected in 659 of the 3305 men in the dutasteride group , as compared with 858 of the 3424 men in the placebo group , representing a relative risk reduction with dutasteride of 22.8 % ( 95 % confidence interval , 15.2 to 29.8 ) over the 4-year study period ( P<0.001 ) . Overall , in years 1 through 4 , among the 6706 men who underwent a needle biopsy , there were 220 tumors with a Gleason score of 7 to 10 among 3299 men in the dutasteride group and 233 among 3407 men in the placebo group ( P=0.81 ) . During years 3 and 4 , there were 12 tumors with a Gleason score of 8 to 10 in the dutasteride group , as compared with only 1 in the placebo group ( P=0.003 ) . Dutasteride therapy , as compared with placebo , result ed in a reduction in the rate of acute urinary retention ( 1.6 % vs. 6.7 % , a 77.3 % relative reduction ) . The incidence of adverse events was similar to that in studies of dutasteride therapy for benign prostatic hyperplasia , except that in our study , as compared with previous studies , the relative incidence of the composite category of cardiac failure was higher in the dutasteride group than in the placebo group ( 0.7 % [ 30 men ] vs. 0.4 % [ 16 men ] , P=0.03 ) . CONCLUSIONS Over the course of the 4-year study period , dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia . ( Clinical Trials.gov number , NCT00056407 .
This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .