MAIN RESULTS Finasteride consistently improved urinary symptom scores more than placebo in trials of > 1 year duration , and significantly lowered the risk of BPH progression ( acute urinary retention , risk of surgical intervention , ≥ 4 point increase in the AUASI/IPSS ) .
In comparison to alpha-blocker monotherapy , finasteride was less effective than either doxazosin or terazosin , but equally effective compared to tamsulosin .
Both doxazosin and terazosin were significantly more likely than finasteride to improve peak urine flow and nocturia , versus finasteride .
Versus tamsulosin , peak urine flow and QoL improved equally well versus finasteride .
However , finasteride was associated with a lower risk of surgical intervention compared to doxazosin , but not to terazosin , while finasteride and doxazosin were no different for risk of acute urinary retention .
Finasteride + doxazosin and doxazosin monotherapy  improved urinary symptoms equally well ( ≥ 4 point improvement).For finasteride , there was an increased risk of ejaculation disorder , impotence , and lowered libido , versus placebo .
Versus doxazosin , finasteride had a lower risk of asthenia , dizziness , and postural hypotension , and versus terazosin , finasteride had a significant , lower risk of asthenia , dizziness , and postural hypotension .
Finasteride improves long-term urinary symptoms versus placebo , but is less effective than doxazosin .
Long-term combination therapy with alpha blockers ( doxazosin , terazosin ) improves symptoms significantly better than finasteride monotherapy .
Finasteride + doxazosin improves symptoms equally - and clinical ly - to doxazosin alone .
Finasteride + doxazosin versus doxazosin  improves scores equally for short and long term .
Drug-related adverse effects for finasteride are rare ; nevertheless , men  taking  finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder , versus placebo .
Versus doxazosin , which has higher rates of dizziness , postural hypotension , and asthenia , men taking finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder .
Finasteride significantly reduces asthenia , postural hypotension , and dizziness versus terazosin .
Finasteride significantly lowers the risk of asthenia , dizziness , ejaculation disorder , and postural hypotension , versus finasteride + terazosin
BACKGROUND Benign prostatic hyperplasia ( BPH ) , a non-malignant enlargement of the prostate in aging men , can cause bothersome urinary symptoms ( intermittency , weak stream , straining , urgency , frequency , incomplete emptying ) .
Finasteride , a five-alpha reductase inhibitor ( 5ARI ) , blocks the conversion of testosterone to dihydrotestosterone , reduces prostate size , and is commonly used to treat symptoms associated with BPH .
OBJECTIVES To compare the clinical effectiveness and harms of finasteride versus placebo and active controls in the treatment of lower urinary tract symptoms ( LUTS ) .
Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia.
OBJECTIVES To evaluate the incidence and resolution of sexual adverse experiences ( AEs ) in men with benign prostatic hyperplasia treated with finasteride 5 mg compared with placebo . METHODS The Proscar Long-term Efficacy and Safety Study ( PLESS ) was a 4-year , r and omized , double-blind , placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men , aged 45 to 78 years , with symptomatic benign prostatic hyperplasia , enlarged prostates , and no evidence of prostate cancer . Patients completed a question naire at screening regarding their history of sexual dysfunction . During treatment , spontaneously self-reported sexual AEs were recorded . RESULTS At screening , 46 % of patients in each treatment group reported some history of sexual dysfunction . During year 1 of the study , 15 % of finasteride-treated patients and 7 % of placebo-treated patients had sexual AEs that were considered drug related by the investigator ( P < 0.001 ) . During years 2 to 4 , no between-group difference was noted in the incidence of new sexual AEs ( 7 % in each group ) . The drug-related sexual AE profile for finasteride was similar for men with or without a history of sexual dysfunction . Sexual AEs resolved while continuing therapy in 12 % of finasteride patients and 19 % of placebo patients . Only 4 % of finasteride and 2 % of placebo patients discontinued the study because of sexual AEs . In men who discontinued with a sexual AE , 50 % and 41 % experienced resolution of their sexual AE after discontinuing finasteride or placebo therapy , respectively . CONCLUSIONS Compared with placebo , men treated with finasteride experienced new drug-related sexual AEs with an increased incidence only during the first year of therapy
MAIN RESULTS Finasteride consistently improved urinary symptom scores more than placebo in trials of > 1 year duration , and significantly lowered the risk of BPH progression ( acute urinary retention , risk of surgical intervention , ≥ 4 point increase in the AUASI/IPSS ) .
In comparison to alpha-blocker monotherapy , finasteride was less effective than either doxazosin or terazosin , but equally effective compared to tamsulosin .
Both doxazosin and terazosin were significantly more likely than finasteride to improve peak urine flow and nocturia , versus finasteride .
Versus tamsulosin , peak urine flow and QoL improved equally well versus finasteride .
However , finasteride was associated with a lower risk of surgical intervention compared to doxazosin , but not to terazosin , while finasteride and doxazosin were no different for risk of acute urinary retention .
Finasteride + doxazosin and doxazosin monotherapy  improved urinary symptoms equally well ( ≥ 4 point improvement).For finasteride , there was an increased risk of ejaculation disorder , impotence , and lowered libido , versus placebo .
Versus doxazosin , finasteride had a lower risk of asthenia , dizziness , and postural hypotension , and versus terazosin , finasteride had a significant , lower risk of asthenia , dizziness , and postural hypotension .
Finasteride improves long-term urinary symptoms versus placebo , but is less effective than doxazosin .
Long-term combination therapy with alpha blockers ( doxazosin , terazosin ) improves symptoms significantly better than finasteride monotherapy .
Finasteride + doxazosin improves symptoms equally - and clinical ly - to doxazosin alone .
Finasteride + doxazosin versus doxazosin  improves scores equally for short and long term .
Drug-related adverse effects for finasteride are rare ; nevertheless , men  taking  finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder , versus placebo .
Versus doxazosin , which has higher rates of dizziness , postural hypotension , and asthenia , men taking finasteride are at increased risk for impotence , erectile dysfunction , decreased libido , and ejaculation disorder .
Finasteride significantly reduces asthenia , postural hypotension , and dizziness versus terazosin .
Finasteride significantly lowers the risk of asthenia , dizziness , ejaculation disorder , and postural hypotension , versus finasteride + terazosin
BACKGROUND Benign prostatic hyperplasia ( BPH ) , a non-malignant enlargement of the prostate in aging men , can cause bothersome urinary symptoms ( intermittency , weak stream , straining , urgency , frequency , incomplete emptying ) .
Finasteride , a five-alpha reductase inhibitor ( 5ARI ) , blocks the conversion of testosterone to dihydrotestosterone , reduces prostate size , and is commonly used to treat symptoms associated with BPH .
OBJECTIVES To compare the clinical effectiveness and harms of finasteride versus placebo and active controls in the treatment of lower urinary tract symptoms ( LUTS ) .