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Back to the future for urological drug development?

Over the last few years several long-term studies, by design or accident, have had a potentially negative impact on the future of urological and andrological drug research and development. The more positive of these have included the Medical Treatment Of Prostatic Symptoms, which ultimately showed that either 5 a -reductase inhibitor (finasteride) or a -blocker (doxazosin) therapy was good as monotherapy but also offered advantages (apart from cost perhaps) when used in combination. It is not known whether this has any actual impact on the extent of the coadministration of these drugs in the real world. Initially, the results with finasteride from the Prostate Cancer Prevention Trial were more equivocal, showing a lower incidence of prostate carcinoma but apparently a higher grade when manifest. However, it now appears that the latter is artefactual and the data augers well for the use of finasteride, at least in preventing prostate cancer. It remains to be seen what the outcome of a similar study involving GSK’s dutasteride will be in terms of both efficacy and artefact.