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Men With Benign Prostate Hyperplasia, Obstruction Symptoms, Can Switch From Alpha-Blocker To Finasteride: Presented at AUA

By Paula Moyer

CHICAGO, IL -- May 5, 2003 -- Men with benign prostate hyperplasia (BPH) who have both a large prostate and lower urinary tract symptoms can switch from an alpha-blocker to finasteride (Proscar), a 5-alpha reductase inhibitor, and maintain improved symptom scores.

"When we switched patients to finasteride, we saw reduction of prostate growth and a reduced risk of BPH progression," said Stuart M. Diamond, MD, assistant professor of urology at Thomas Jefferson University in Philadelphia. "They also had improvements in their symptoms scores." Dr. Diamond is also the director of the urology residency program. He presented his and his co-investigators' findings here April 30^th at the 98^th Annual Meeting of the American Urological Association (AUA).

The researchers had, in an earlier study, successfully switched such patients from successful alpha blockade with tamsulosin (Flomax) to combination therapy with finasteride, and then discontinued tamsulosin. In the current research, they re-evaluated the study patients at 6, 12, and 18 months to see whether their symptom scores changed on finasteride monotherapy.

The initial study involved 75 patients with enlarged prostate glands, larger than 40 gm and AUA symptom scores greater than 15. All of the patients had taken tamsulosin for at least 1 year and were taking it at the time of evaluation. All the patients reported that they satisfied with the drug's effectiveness.

The investigators had placed the patients on combination therapy with finasteride and randomised them to discontinue tamsulosin at 6, 9, or 12 months after beginning combination treatment. Among these, 49 patients (65.3%) successfully discontinued alpha blockade and remained on finasteride monotherapy.

Dr. Diamond and his co-investigators re-evaluated the patients at six, 12, and 18 months after the trial had ended. They wanted to know if patients' AUA symptom score had elevated. They monitored patient satisfaction with the Short Form 36 questionnaire (SF 36), a short version of a general health questionnaire. The patients responded to the SF 36 when they entered the trial and on follow-up visits.

Among the 49 patients who completed the study, 45 (92%) had either no change or a reduction in their AUA symptom score when scores were compared to their scores 1 month after discontinuing tamsulosin. When symptom scores were compared to the end of the trial, 35% had no change and 65% had reduced scores. Overall, 90% of the patients had stable or improved voiding with finasteride monotherapy six months after they had stopped tamsulosin.

Twelve-month data was available on 45 patients; among these, 40 (89%) had stable or improved voiding at 1 year after discontinuing tamsulosin. At 18 months after discontinuation, 25 patients were available for review and 23 (92%) had similar scores.

The participants' responses to the SF 36 questionnaire showed an improvement at the end of the study, with mean scores reflecting an improved quality of life at the end of the trial compared to baseline scores. These scores remained stable or improved in over 90% of the patients during the post-trial follow-up, Dr. Diamond said.

"The findings show that patients with enlarged prostates and lower urinary tract symptoms (LUTS) who are already receiving tamsulosin treatment are likely to tolerate discontinuation of tamsulosin after they have had combination treatment with finasteride for 9 to 12 months," Dr. Diamond said. He said that the follow-up data show that the switch to finasteride monotherapy is apparently durable. Future research may involve switching men with BPH who have smaller prostate glands, averaging 36 g.

No pharmaceutical company funded the study, said Dr. Diamond

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