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 ) .
Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study.
PURPOSE We analyze patterns of prostate growth in men diagnosed with benign prostatic hyperplasia ( BPH ) and treated with placebo  during 4 years , and determine which baseline parameters were the strongest predictors of growth . MATERIAL S AND METHODS A total of 3,040 men were enrolled in the 4-year r and omized , placebo controlled Proscar Long-Term Efficacy and Safety study . Of these men a subgroup of 10 % underwent pelvic magnetic resonance imaging prostate volume measurement at baseline and yearly thereafter . Absolute and percent volume changes during 4 years were calculated in the 164 placebo treated men in the subgroup . The ability of age , baseline prostate volume and prostate specific antigen ( PSA ) to predict prostate growth in placebo treated patients was assessed by multiple linear regression analyses , receiver operator characteristics curves , and evaluations of growth stratified by tertiles of baseline serum PSA and decades of life . RESULTS In placebo treated patients a steady increase in mean plus or minus st and ard deviation prostate volume from year to year was noted ( 2.5+/-6.1 , 4.9+/-6.8 , 6.4+/-8.5 and 7.2+/-8.8 ml . at years 1 , 2 , 3 and 4 , respectively ) . Mean volume changes at 4 years ranged from -9 to + 30 ml . Mean percent change from baseline ranged from 12.5 % to 16.6 % for men 50 to 59 years old to those 70 to 79 years old . Baseline serum PSA was a strong predictor of growth with 7.4 % to 22.0 % change at 4 years from the lowest to highest PSA tertiles . Annualized growth rates from baseline were 0.7 ml . per year for PSA 0.2 to 1.3 , 2.1 for PSA 1.4 to 3.2 and 3.3 for PSA 3.3 to 9.9 ng./ml . Multiple linear regression analysis showed that serum PSA was a stronger predictor of prostate growth than age or baseline prostate volume . All but 1 man with baseline serum PSA greater than 2.0 ng./ml . had prostate growth during 4 years , and 32.6 % of men with serum PSA less than 2.0 exhibited a decrease in volume . CONCLUSIONS Serum PSA is a stronger predictor of growth of the prostate in placebo treated patients than age or baseline prostate volume . Since prostate volume is a risk factor for acute urinary retention and the need for BPH related surgery , the ability of PSA to predict prostate growth may be an important factor when considering individual treatment options for BPH . Such use of PSA represents a shift in paradigm away from focusing solely on symptoms of BPH toward a more comprehensive approach with consideration of predicting and preventing risk factors of BPH related outcomes
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 ) .