Who will benefit from combination therapy? The role of 5 alpha reductase inhibitors and alpha blockade: a reflection from MTOPS.

PURPOSE OF REVIEW: The purpose of this review is to revisit the medical treatment of benign prostatic hyperplasia in the light of the most recent data concerning the association of alpha-blockers and 5alpha-reductase inhibitors. Combining these two drugs is not a new concept in treating benign prostatic hyperplasia patients. Alpha blockers are believed to improve symptoms and flow rate by inducing relaxation of the smooth muscle neck and prostate area (dynamic component), while 5alpha-reductase inhibitors are believed to improve symptoms and flow rate by shrinking the transition zone of the prostate through hormonal mechanisms (static component). The proof of this concept, however, could not be clinically demonstrated up until now. The design of previous studies investigating combination therapy with the 5alpha-reductase inhibitor finasteride has been questionable. RECENT
FINDINGS: Extrapolated from the Medical Therapy of Prostatic Symptoms (MTOPS) study, not yet fully published, again raises the question of the effectiveness of such a combination. There is now some evidence to suggest that combining alpha-blockers and finasteride may be more effective in relieving and preventing the progression of symptoms than either of the two drugs alone.
SUMMARY: Patients most likely to benefit from combination therapy are those in whom baseline risk of progression is significantly higher, generally patients with larger glands and higher prostatic specific antigen values.