title: Rates of prostate surgery and acute urinary retention for benign prostatic hyperplasia in men treated with dutasteride or finasteride.
abstract: BACKGROUND
  Previous studies have suggested a greater benefit for various outcomes in men diagnosed with benign prostatic hyperplasia (BPH) who are treated with dutasteride than for men treated with finasteride. This study investigates whether the rates of BPH-related prostate surgery and acute urinary retention (AUR) differ between dutasteride and finasteride users in the Netherlands.
  
  
  METHODS
  From the PHARMO Database Network, men aged ≥50 years with a dispensing of dutasteride or finasteride with or without concomitant alpha-blocker treatment between March 1, 2003 and December 31, 2011 were selected. The incidence of BPH-related prostate surgery and AUR was determined during dutasteride or finasteride treatment and stratified by type of initial BPH-treatment (5-ARI monotherapy or combination with alpha-blocker) and prescriber (general practitioner (GP) or urologist). Comparison of the incidence of BPH-related prostate surgery and AUR between the treatment groups was done by Cox proportional hazard regression.
  
  
  RESULTS
  11,822 dutasteride users and 5,781 finasteride users were identified. Most users started treatment in combination with an alpha-blocker. Overall, dutasteride users had a lower risk of BPH-related prostate surgery was lower among dutasteride users than finasteride users (HR: 0.75; 95 % CI: 0.56-0.99). This lower risk among dutasteride users was also seen when stratifying by monotherapy or combination therapy (HR: 0.73; 95 % CI: 0.54-0.98 for monotherapy and HR: 0.85; 95 % CI: 0.74-0.97 for combination therapy). However, the association was only present among men treated by urologists. For AUR the rates were low and no statistical significant difference was observed between dutasteride and finasteride users.
  
  
  CONCLUSIONS
  The risk of undergoing BPH-related prostate surgery was lower among men using dutasteride compared to men using finasteride. The association was observed for monotherapy as well as combination therapy, however, only among men who received their prescription from a urologist.
authors: PHARMO Institute for Drug Outcomes Research, van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands. josine.kuiper@pharmo.nl.
authors: Josephina G
authors: JG
authors: Kuiper
authors: PHARMO Institute for Drug Outcomes Research, van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands.
authors: Irene D
authors: ID
authors: Bezemer
authors: GlaxoSmithKline, 980 Great West Road, TW8 9 GS, Brentford, London, UK.
authors: Maurice T
authors: MT
authors: Driessen
authors: GlaxoSmithKline, 980 Great West Rd, Brentford, London, UK.
authors: Averyan
authors: A
authors: Vasylyev
authors: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Bldv, TX 75390, Dallas, TX, USA.
authors: Claus G
authors: CG
authors: Roehrborn
authors: PHARMO Institute for Drug Outcomes Research, van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands.
authors: Fernie J A
authors: FJ
authors: Penning-van Beest
authors: PHARMO Institute for Drug Outcomes Research, van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands.
authors: Ron M C
authors: RM
authors: Herings
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000068538:Dutasteride / Q000627:therapeutic use*; D018120:Finasteride / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000601:surgery*; D016055:Urinary Retention / Q000453:epidemiology* / Q000209:etiology*
chemical_list: D058891:5-alpha Reductase Inhibitors; D018120:Finasteride; D000068538:Dutasteride
keywords: 5-alpha reductase inhibitors; Acute urinary retention; Alpha-blocker; Benign prostatic hyperplasia; Prostate surgery