title: Discontinuation of alpha-blockade after initial treatment with finasteride and doxazosin in men with lower urinary tract symptoms and clinical evidence of benign prostatic hyperplasia.
abstract: OBJECTIVE
  To determine the effect of discontinuation of alpha-blockade and continuation of finasteride in men with lower urinary tract symptoms and enlarged prostates receiving combination treatment and to determine whether the alpha-blocker dose influences the ability to discontinue it.
  
  
  METHODS
  We treated 272 consecutive men with a prostate size greater than 40 g and American Urological Association symptom score greater than 20 with 5 mg finasteride and 2 mg doxazosin daily. Two hundred forty men reported a favorable response to therapy, defined as any reduction in symptom score and toleration of the medications. The dose was maintained at 2 mg doxazosin in 100 men and was titrated to 4 mg doxazosin in 80 patients and to 8 mg doxazosin in an additional 60 patients. We discontinued doxazosin at 3, 6, 9, or 12 months, while continuing finasteride, and then re-evaluated the patients 1 month later to determine whether any worsening of symptoms had resulted.
  
  
  RESULTS
  In patients discontinuing doxazosin at 3 months, success (defined as no increase in symptom score and no desire to resume doxazosin) was reported by 20%, 15%, and 13% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 6 months, success was reported by 48%, 45%, and 40% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 9 months, success was reported by 84%, 80%, and 73% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 12 months, success was reported by 84%, 85%, and 87% of those taking 2, 4, and 8 mg, respectively.
  
  
  CONCLUSIONS
  Patients with lower urinary tract symptoms and moderately enlarged prostates initially receiving combination therapy using finasteride and an alpha-blocker are likely to experience no significant symptom deterioration after discontinuing the alpha-blocker after 9 to 12 months of combination therapy regardless of the dose of alpha-blocker chosen.
authors.affiliation: Division of Urology, Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Baldwin
authors.forename: P C
authors.initials: PC
authors.lastname: Ginsberg
authors.forename: C G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: R C
authors.initials: RC
authors.lastname: Harkaway
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000368:Aged; D017292:Doxazosin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D018120:Finasteride / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D018120:Finasteride; D017292:Doxazosin