title: Combination of tadalafil and finasteride for improving the symptoms of benign prostatic hyperplasia: critical appraisal and patient focus.
abstract: The evidence suggests that combination therapy for benign prostatic hyperplasia (BPH)-lower urinary tract symptoms (LUTS) using an α-blocker and a 5α-reductase inhibitor has become well accepted. The combination of daily tadalafil and an α-blocker has also demonstrated benefit. This paper addresses combination therapy with daily tadalafil and finasteride for the treatment of BPH-LUTS. Our results demonstrate that use of tadalafil and finasteride represents a logical extension of combination therapies. We analyze a landmark study by Casabé et al that demonstrates improved voiding symptoms as assessed by International Prostate Symptom Scores with a combination of tadalafil and finasteride compared with finasteride and placebo. Study patients had moderate to severe LUTS and prostate volumes >30 g. The additional benefit of improved erectile function as assessed by International Index of Erectile Function-erectile function domain scores with the addition of tadalafil was a secondary benefit. We propose that the ideal patient for combination therapy with tadalafil and finasteride has a prostate volume >30 g and desires additional benefit over monotherapy. For these men, improved erectile function without sexual side effects was a secondary benefit.
authors.affiliation: Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Elkelany
authors.affiliation: Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Owen
authors.affiliation: Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Kim
keywords: benign prostatic hyperplasia; finasteride; lower urinary tract symptoms; tadalafil
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