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 .
The influence of finasteride on the development of prostate cancer.
BACKGROUND And rogens are involved in the development of prostate cancer . Finasteride , an inhibitor of 5alpha-reductase , inhibits the conversion of testosterone to dihydrotestosterone , the primary and rogen in the prostate , and may reduce the risk of prostate cancer . METHODS In the Prostate Cancer Prevention Trial , we r and omly assigned 18,882 men 55 years of age or older with a normal digital rectal examination and a prostate-specific antigen ( PSA ) level of 3.0 ng per milliliter or lower to treatment with finasteride ( 5 mg per day ) or placebo for seven years .  Prostate biopsy was recommended if the annual PSA level , adjusted for the effect of finasteride , exceeded 4.0 ng per milliliter or if the digital rectal examination was abnormal . It was anticipated that 60 percent of participants would have prostate cancer diagnosed during the study or would undergo biopsy at the end of the study . The primary end point was the prevalence of prostate cancer during the seven years of the study . RESULTS Prostate cancer was detected in 803 of the 4368 men in the  finasteride  group who had data for the final analysis ( 18.4 percent ) and 1147 of the 4692 men in the placebo group who had such data ( 24.4 percent ) , for a 24.8 percent reduction in prevalence over the seven-year period ( 95 percent confidence interval , 18.6 to 30.6 percent ; P<0.001 ) . Tumors of Gleason grade 7 , 8 , 9 , or 10 were more common in the finasteride group ( 280 of 757 tumors [ 37.0 percent ] , or 6.4 percent of the 4368 men included in the final analysis ) than in the placebo group ( 237 of 1068 tumors [ 22.2 percent ] , P<0.001 for the comparison between groups ; or 5.1 percent of the 4692 men included in the final analysis , P=0.005 for the comparison between groups ) . Sexual side effects were more common in finasteride-treated men , whereas urinary symptoms were more common in men receiving placebo . CONCLUSIONS Finasteride prevents or delays the appearance of prostate cancer , but this possible benefit and a reduced risk of urinary problems must be weighed against sexual side effects and the increased risk of high- grade prostate cancer
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 .