Effect of Discontinuation of 5alpha-Reductase Inhibitors on Prostate Volume and Symptoms in Men With BPH: A Prospective Study; Jeong YB, Kwon KS, Kim SD, Kim HJ; Urology (Feb 2009)

OBJECTIVES: To investigate the change in prostate volume and symptoms after discontinuation of 5alpha-reductase inhibitors (5ARIs) in men with moderate to severe symptoms due to benign prostatic hyperplasia (BPH). METHODS: A total of 120 patients with BPH were enrolled from December 2004 to May 2008. The patients were randomized into 2 groups: group 1 received finasteride 5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily, and group 2 received dutasteride 0.5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily. All the patients received combination therapy for 1 year, followed by 1 year of alpha-blocker monotherapy. The prostate volume, International Prostate Symptom Score, and serum prostate-specific antigen level were determined at baseline and at 12 and 24 months after treatment. RESULTS: At 1 year after treatment, the prostate volume was reduced by 24.5% +/- 10.01% (P<.001) in group 1 and by 26.1% +/- 5.06% (P<.001) in group 2. One year after withdrawal of the 5ARIs, the prostate volume had increased by 20.7% +/- 14.1% (P<.001) and 18.6% +/- 7.4% (P<.001) in groups 1 and 2, respectively, compared with at the end of 1 year of treatment. Furthermore, the International Prostate Symptom Score had significantly deteriorated at 1 year after cessation of the 5ARIs in both groups compared with the values at the end of 1 year of combination therapy. CONCLUSIONS: Our data demonstrate that the discontinuation of 5ARIs during combination therapy induces prostate regrowth, as well as aggravation of symptoms in men with BPH. This result, therefore, suggests that the life-long use of 5ARIs should be considered for the prevention of BPH progression.