Men taking drugs known as 5-alpha reductase inhibitors
(5-ARIs) to treat benign prostatic hyperplasia (BPH, or enlarged prostate) may face a modestly increased risk of type 2 diabetes compared with another type of BPH medication, recent evidence suggests.
Now there are three classes of medications: alpha blockers (Tamsulosin and others), 5-alpha reductase inhibitors
(Finasteride and others) and the phosphodiesterase-5 Inhibitor Tadalafil.
Adverse Effects and Safety of 5-Alpha Reductase Inhibitors
(Finasteride, Dutasteride): A Systematic Review.
Although medical treatment of BPH with alpha blockers and 5-alpha reductase inhibitors
may ameliorate the urinary symptoms, surgical intervention may be inevitable in some patients.
Dutasteride inhibits 5AR types 1 and 2.[sup.8] Two studies have shown that 5-alpha reductase inhibitors
(5ARIs) reduce the risk of prostate cancer.[sup.9,10] In men with benign prostatic hyperplasia (BPH), 5ARIs reduce serum prostate-specific antigen (PSA) levels by 50% to 66%.[sup.11,12]
Reasons for the current stagnation of progress include failure of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) to show preventive activity of selenium and vitamin E; the failure of a high-risk phase III study to show preventive activity of selenized yeast; the refusal of the Food and Drug Administration to approve finasteride for prostate cancer prevention; and uncertainty regarding the long-term effects of treatment with 5-alpha reductase inhibitors
, according to Dr.
There is a need for randomized controlled trials to analyze the efficacy and side-effects of combination therapy with PDE-5 inhibitors and 5-alpha reductase inhibitors
. Age, BMI and LUTS severity seem to be important parameters in determining the most appropriate candidates for PDE-5 inhibitor treatment.
A review of several published reports attribute the higher Gleason scores observed in the groups taking the 5-alpha reductase inhibitors
(Avodart[R] or Proscar[R]) to the fact that it was easier to find high-grade cancers in the shrunken glands of men taking these drugs compared to the much larger glands of men in the placebo group.
The two main classes of BPH drugs: alpha blockers like Flomax and UroXatral, which relax the muscles of the bladder neck and prostate, and 5-alpha reductase inhibitors
like Proscar and Avodart, which lower levels of hormones produced by the prostate.
For men with significant enlargement, drugs called 5-alpha reductase inhibitors
(5-ARIs) are available to shrink the prostate.
These include alpha blockers like tamsulosin (Flomax), which provide quick symptom relief, and 5-alpha reductase inhibitors
like dutasteride (Avodart), which help shrink the prostate over time.
Finasteride (Proscar[R], Propecia[R]) and dutasteride (Avodart[R]) are in a class of medications called 5-alpha reductase inhibitors
because they block the effects of the enzyme and prevent the conversion of testosterone to DHT, but they don't reduce testosterone levels.