Clinical effects of discontinuing 5-alpha reductase inhibitor in patients with benign prostatic hyperplasia.
OBJECTIVE
To assess changes in lower urinary tract symptoms (LUTS), prostate volume, and serum prostate-specific antigen (PSA) after discontinuation of 5-alpha reductase inhibitor (5ARI) combination therapy in patients with benign prostatic hyperplasia (BPH).


METHODS
From December 2003 to December 2012, data were collected retrospectively from 81 men more than 40 years of age with moderate to severe BPH symptoms (International Prostate Symptom Score [IPSS]≥8). The men were classified into group 1 (n=42) and group 2 (n=39) according to the use of 5ARI therapy. A combination of dutasteride 0.5 mg with tamsulosin 0.2 mg was given daily to all patients for 1 year. For the next 1 year, group 1 (n=42) received the combination therapy and group 2 (n=39) received tamsulosin 0.2 mg monotherapy only. The IPSS, prostate volume, and PSA level were measured at baseline and at 12 and 24 months according to the use of dutasteride.


RESULTS
Discontinuation of dutasteride led to significant deterioration of LUTS, increased prostate volume, and increased PSA level. The repeated-measures analysis of variance showed that the changes in IPSS, prostate volume, and PSA level over time also differed significantly between groups 1 and 2 (p<0.001).


CONCLUSIONS
Withdrawal of 5ARI during combination therapy resulted in prostate regrowth and deterioration of LUTS. The PSA level is also affected by the use of 5ARI. Therefore, regular check-up of the IPSS and PSA level may be helpful for all patients who either continue or discontinue the use of 5ARI.
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Won
W
Kim
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jae Hung
JH
Jung
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Tae Wook
TW
Kang
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jae Mann
JM
Song
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Hyun Chul
HC
Chung
5-Alpha reductase inhibitors; Prostate specific antigen; Prostatic hyperplasia