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The impact of 5-alpha-reductase inhibitors on the number of prostatectomies for benign prostatic hyperplasia.

To determine the impact of a 5-alpha-reductase inhibitor on the need for surgical treatment of symptomatic benign prostatic hyperplasia (BPH) in clinical urologic practice, we retrospectively reviewed records of 794 patients treated with pharmacotherapy or surgery (or both). The number of transurethral resections of the prostate (TURPs) performed during the 30 months since introduction of finasteride was compared with the number performed during the 30 months before finasteride became available. The alpha-blockers doxazosin and prazosin were used during both times for the treatment of BPH. Of the 619 patients treated with drugs, 88.5% received finasteride for a mean of 249.6 days. The alpha-blockers, either alone or combined with finasteride, were prescribed for 11.5% of patients for a mean of 179 days. In the 30 months after the introduction of finasteride, 65 patients underwent TURP: 28 of these men had initially received drug therapy. In contrast, 138 TURPs were performed in the 30 months prior to the availability of finasteride. The use of a 5-alpha-reductase inhibitor as primary medical therapy for symptomatic BPH decreased the number of prostatectomies by 52.9% (65 vs 138). This observation warrants corroboration through additional prospective studies.