title: Current Pharmacological Treatment for Male LUTS due to BPH: Dutasteride or Finasteride?
abstract: Benign prostatic hyperplasia (BPH) is a potentially progressive disease which is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. In the current medical therapy scenario for LUTS attributed to BPH, only one class of drugs, 5-α reductase inhibitors (5ARIs), has been found to be effective in reducing the risk of disease progression. The two 5ARIs that are currently available include finasteride and dutasteride. These two drugs have different pharmacokinetic and pharmacodynamic properties. Greater suppression of dehydrotestosterone is achieved by dutasteride (>90% dutasteride vs 70% finasteride) which theoretically should correlate with greater efficacy in alleviating urinary symptoms. Unfortunately, this hypothesis has not yet been clinically demonstrated. The pertinent literature is scarce and heterogeneous and produces low scientific levels of evidence. The present review article aims to evaluate the comparative head-to-head studies in order to evaluate if the hypothetical clinical differences between dutasteride and finasteride do exist. Pharmacological treatment with either drug results in similar symptom improvements; however dutasteride seems to have a better profile in reducing the risk of prostate surgery and acute urinary retention (AUR). More studies are necessary to better evaluate both the clinical and pharmacoeconomic profile of the two 5ARIs.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Fondazione "Mario Negri Sud", Santa Maria Imbaro, Italy. pirozzi@negrisud.it.
authors.forename: Luisella
authors.initials: L
authors.lastname: Pirozzi
authors.forename: Petros
authors.initials: P
authors.lastname: Sountoulides
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellan
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Presicce
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lombardo
authors.forename: Marilena
authors.initials: M
authors.lastname: Romero
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000068538:Dutasteride / Q000627:therapeutic use*; D018120:Finasteride / Q000627:therapeutic use*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D018120:Finasteride; D000068538:Dutasteride