5α-reductase inhibitor treatment of prostatic diseases: background and practical implications

5α-reductase inhibitor treatment of prostatic diseases: background and practical implications

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ABSTRACT This literature review discusses the theoretical background of 5α-reductase inhibitor (5ARI) treatment and the resulting clinical implications. A Medline-based search for peer-reviewed articles addressing 5ARIs, benign prostatic hyperplasia and prostate cancer was performed. The 5ARIs Finasteride and Dutasteride, which specifically inhibit the production of dihydrotestosterone by acting as competitive inhibitors of 5α-reductase, are clinically well tolerated and represent an effective treatment option for benign prostatic obstruction. Finasteride is the first compound which has a proven efficacy in chemoprevention of prostate cancer. The aim of this review was to elucidate, if there are sufficient data available to point out clinically relevant differences between the drugs. Both compounds achieve a significant reduction of prostate volume, an improvement of symptoms and a lower risk of acute urinary retention. Whether the different pharmacokinetic and pharmacodynamic properties of Finasteride and Dutasteride are of clinical importance cannot be judged at this time. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 4 print issues and online access $259.00 per year only $64.75 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS THE POST-FINASTERIDE SYNDROME: POSSIBLE ETIOLOGICAL MECHANISMS AND SYMPTOMS Article 11 September 2023 PSA RESPONSE TO ANTIANDROGEN WITHDRAWAL: A SYSTEMATIC REVIEW AND META-ANALYSIS Article 18 February 2021 SAFETY PROFILE OF DAROLUTAMIDE VERSUS PLACEBO: A SYSTEMATIC REVIEW AND META-ANALYSIS Article 14 December 2023 REFERENCES * Roehrborn CG, Lukkarinen O, Mark S, Siami P, Ramsdell N, Zinner N . Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5α-reductase inhibitor dutasteride: results of 4-year studies. _BJU Int_ 2005; 96: 572–577. Article  Google Scholar  * Russel DW, Wilson JD . Steroid 5α-reductase: two genes, two enzymes. _Annu Rev Biochem_ 1994; 63: 25–61. Article  Google Scholar  * Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD . The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. _J Urol_ 1993; 150: 379–385. Article  CAS  Google Scholar  * Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C _et al_. Cancer statistics 2006. _Ca Cancer J Clin_ 2006; 56: 106–130. Article  Google Scholar  * Iehle C, Radvanyi F, Gil Diez de Medina S, Ouafik LH, Gérard H, Chopin D _et al_. Differences in steroid 5α-reductase isoenzyme expression between normal and pathological human prostate tissue. _J Steroid Biochem Mol Biol_ 1999; 68: 189–195. Article  CAS  Google Scholar  * Andriole G, Bruchovsky N, Chung LWK, Matsumoto AM, Rittmaster R, Roehrborn C _et al_. Dihydrotestosterone and the prostate: the scientific rationale for 5α-reductase inhibitors in the treatment of benign prostatic hyperplasia. _J Urol_ 2004; 172: 1399–1403. Article  CAS  Google Scholar  * Le H, Arnold JT, McFann KK, Blackmann MR . DHT and testosterone but not DHEA or E2 differentially modulate IGF-I, IGFBP-3 in human prostatic stromal cells. _Am J Physiol Endocrinol Metab_ 2006; 290: E952–E960. Article  CAS  Google Scholar  * Thomas LN, Douglas RC, Vessey JP, Gupta R, Fontaine D, Norman RW _et al_. 5α-Reduction type 1 immunostaining is enhanced in some prostate cancers compared with BPH epithelium. _J Urol_ 2003; 170: 2019–2025. Article  CAS  Google Scholar  * Thomas LH, Lazier CB, Gupta R, Norman RW, Thompson IM, Troyer DA _et al_. Differential alterations in 5α-reductase type 1 and type 2 levels during development and progression of prostatae cancer. _Prostate_ 2004; 58: 1–9. Article  Google Scholar  * Luo J, Dunn TA, Ewing CM, Walsh PC, Isaacs WB . Decreased gene expression of steroid 5α-reductase 2 in human prostate cancer: implication for finasteride therapy of prostate carcinoma. _Prostate_ 2003; 57: 134–139. Article  CAS  Google Scholar  * Walsh PC, Madden JD, Harrod MJ, Goldstein JL, MacDonald PC, Wilson JD . Familial incomplete male pseudohermaphroditism type 2. Decreased DHT formation in pseudovaginal, perineoscrotal hypospadias. _N Engl J Med_ 1974; 291: 944–949. Article  CAS  Google Scholar  * Steers WD . 5α-Reductase activity in the prostate. _Urology_ 2001; 58 (Suppl 1): 17–24. Article  CAS  Google Scholar  * Evans HC, Goa KL . Dutasteride. _Drugs Aging_ 2003; 20: 905–916. Article  CAS  Google Scholar  * Frye SV . Discovery and clinical development of dutasteride, a potent dual 5α-reductase inhibitor. _Curr Top Med Chem_ 2006; 6: 405–421. Article  CAS  Google Scholar  * Steiner JF . Clinical pharmacokinetics and pharacodynamics of finasteride. _Clin Pharmacokinet_ 1996; 30: 16–27. Article  CAS  Google Scholar  * Clark RV, Hermann DJ, Cunnungham GR, Wilson TH, Morril BB, Hobbs S . Marked suppression of DHT in men with benign prostatic hyperplasia by dutasteride, a dual 5α-reductase inhibitor. _J Clin Endocrinol Metab_ 2004; 89: 2179–2184. Article  CAS  Google Scholar  * Marks LS, Roehrborn CG, Rittmaster RS . Duration of DHT suppression following discontinuation of dutasteride: implication for missed doses. _J Urol_ 2004; 171: 242–243. Article  Google Scholar  * Andriole GL, Guess HA, Epstein JI, Wise H, Kadman D, Crawford ED _et al_. Treatment with finasteride preserves usefulness of PSA in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial. _Urology_ 1998; 52: 195–202. Article  CAS  Google Scholar  * Andriole GL, Marberger M, Roehrborn CG . Clinical usefulness of serum PSA for the detection of prostate cancer is preserved in men receiving the dual 5α-reductase inhibitor dutasteride. _J Urol_ 2006; 175: 1657–1662. Article  CAS  Google Scholar  * Debruyne F, Barkin J, van Erps P, Reis M, Tammela TMJ, Roehrborn CG . Efficacy and safety of long-term treatment with the dual 5α-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. _Eur Urol_ 2004; 45: 488–495. Article  Google Scholar  * Marks LS, Roehrborn CG, Andriole GL . Prevention of benign prostatic hyperplasia disease. _J Urol_ 2006; 176: 1299–1306. Article  Google Scholar  * Roehrborn CG, Boyle P, Gould AI, Waldstreicher J . Serum PSA as a predictor of prostate volume in men with benign prostatic hyperplasia. _Urology_ 1999; 53: 581–589. Article  CAS  Google Scholar  * Roehrborn CG . The potential of serum PSA as a predictor of clinical response in patients with lower urinary tract symptoms and benign prostatic hyperplasia. _BJU Int_ 2004; 93 (Suppl 1): 21–26. Article  Google Scholar  * Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH _et al_. Serum PSA is a strong predictor of future prostate growth in men with prostatic hyperplasia. Proscar long-term efficacy and safety study. _J Urol_ 2000; 163: 13–20. Article  CAS  Google Scholar  * Roehrborn CG, Boyle P, Nickel JC . PSA is a significant predictor of objective parameters in men at risk for BPH progression. _J Urol_ 2003; 169: A1362. Article  Google Scholar  * McConnell JD, Brushkewitz R, Walsh PC, Andriole G, Lieber M, Holtgrewe HL _et al_. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride long-term efficacy and safety study group. _N Engl J Med_ 1998; 338: 557–563. Article  CAS  Google Scholar  * Roehrborn CG, Marks LS, Fenter T, Freedman S, Tuttle J, Gittleman M _et al_. Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. _Urology_ 2004; 63: 709–715. Article  Google Scholar  * Marberger M, Roehrborn CG, Marks LS, Wilson T, Rittmater RS . Relationship among serum testosterone, sexual function and response to treatment in men receiving dutasteride for BPH. _J Clin Endocrinol Metab_ 2006; 91: 1323–1328. Article  CAS  Google Scholar  * Slawin KM, Kattan MW, Roehrborn CG, Wilson T . Development of nomogram to predict acute urinary retention or surgical intervention, with or without dutasteride therapy, in men with BPH. _Urology_ 2006; 67: 84–88. Article  Google Scholar  * Nickel JC . Comparison of clinical trials with finasteride and dutasteride. _Rev Urol_ 2004; 6 (Suppl 9): S31–S39. PubMed  PubMed Central  Google Scholar  * Hagerty JA, Ginsberg PC, Metro MJ, Harkaway RC . A prospective, comparative study of the onset of symptomatic benefit of dutasteride versus finasteride in men with BPH in clinical practice. _J Urol_ 2004; 171: 356–359. Article  Google Scholar  * McConnell JD, Roehrborn CG, Bautista OM, Andriole Jr GL, Dixon CM, Kusek JW _et al_. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of BPH. _N Engl J Med_ 2003; 349: 2387–2398. Article  CAS  Google Scholar  * Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR _et al_. Combination therapy with doxazosin and finasteride for BPH in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater. _J Urol_ 2006; 175: 217–224. Article  CAS  Google Scholar  * Barkin J, Guimaraes M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB . SMART-1: α-blocker therapy can be withdrawn in the majority of men following initial combination therapy with dual 5α-reductase inhibitor dutasteride. _Eur Urol_ 2003; 44: 461–466. Article  CAS  Google Scholar  * Speakman M, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F _et al_. Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/BPH: a combined analysis of external evidence and clinical expertise. _Prostate Cancer Prostatic Dis_ 2005; 8: 369–375. Article  CAS  Google Scholar  * Kelloff GJ, Lippman SM, Dannenberg AJ, Sigman CC, Pearce HL, Reid BJ _et al_. Progress in chemoprevention drug development: the promise of molecular biomarkers for prevention of intraepithelial neoplasia and cancer—a plan to move forward. _Clin Cancer Res_ 2006; 12: 3661–3697. Article  CAS  Google Scholar  * Thompson IM, Goodman J, Tangen CM, Lucia MS, Miller GJ, Ford LG _et al_. The influence of finasteride on the development of prostate cancer. _N Engl J Med_ 2003; 349: 215–224. Article  CAS  Google Scholar  * Klein E . Can prostate cancer be prevented? _Nature Clin Pract Urol_ 2005; 2: 24–31. Article  Google Scholar  * Schatzl G, Madersbacher S, Haitel A, Gsur A, Preyer M, Haidinger G _et al_. Associations of serum testosterone with microvessel densitiy, androgen receptor density and androgen receptor gene polymorphism in prostate cancer. _J Urol_ 2003; 169: 1312–1315. Article  CAS  Google Scholar  * Algaba F, Epstein JI, Aldape HC, Farrow GM, Lopez-Beltran A, Maksem J _et al_. Assessment of prostate carcinoma in core needle biopsy—definition of minimal criteria for the diagnosis of cancer in biopsy material. _Cancer_ 1996; 78: 376–381. Article  CAS  Google Scholar  * Bostwick DG, Qian J, Civantos F, Roehrborn CG, Montirone R . Does finasteride alter the pathology of the prostate and cancer grading? _Clin Prostate Cancer_ 2004; 2: 228–235. Article  CAS  Google Scholar  * Uzzo RG, Wei JT, Waldbaum RS, Perlmutter AP, Byrne JC, Vaughan Jr ED . The influence of prostate size on cancer detection. _Urology_ 1995; 46: 831–836. Article  CAS  Google Scholar  * Akduman B, Crawford ED . Treatment of localized prostate cancer. _Rev Urol_ 2006; 8 (Suppl 2): S15–S21. PubMed  PubMed Central  Google Scholar  * Marberger M, Adolfsson J, Borkowski A, Fitzpatrick J, Kirk D, Prezioso D _et al_. The clinical implications of the prostate cancer prevention trial. _BJU Int_ 2003; 92: 667–671. Article  CAS  Google Scholar  * Redman MV, Tangen CM, Goodman PJ, Coltman CA, Thompson IM . Finasteride does not increase the risk of high-grade prostate cancer: a bias adjusted modelling approach. _Cancer Prev Res_ 2008; doi: 10.1158/1940-6207.CAPR-08-0092. * Lamb JC, Levy MA, Johnson RK, Isaacs JT . Response of rat and human prostatic cancers to the novel 5α-reductase inhibitor, SK&F 105657. _Prostate_ 1992; 21: 15–34. Article  CAS  Google Scholar  * Negri-Cesi P, Colciago A, Poletti A, Motta M . 5α-reductase isoenzymes and aromatase are differentially expressed and active in the androgen-independent human prostate cancer cell lines DU 145 and PC 3. _Prostate_ 1999; 41: 224–232. Article  CAS  Google Scholar  * Gregory CW, Hohnson RT, Mohler JL, French FS, Wilson EM . Androgen receptor stabilization in recurrent prostate cancer is associated with hypersensitivity to low androgen. _Cancer Res_ 2001; 61: 2892–2898. CAS  PubMed  Google Scholar  * Zhu YS, Cai LQ, You X, Cordero JJ, Huang J, Imperato-McGinley J . Androgen-induced prostate-specific antigen gene expression is mediated via dihydrotestosterone in LNCaP cells. _J Androl_ 2003; 24: 681–687. Article  CAS  Google Scholar  * Xu Y, Dalrymple SL, Becker RE, Denmeade SR, Isaacs JT . Pharmacologic basis for the enhanced efficacy of dutasteride against prostatic cancers. _Clin Cancer Res_ 2006; 12: 4072–4079. Article  CAS  Google Scholar  * Lazier CB, Thomas LN, Douglas RC, Vessey JP, Rittmaster RS . Dutasteride, the 5α-reductase inhibitor, inhibits androgen action and promotes cell death in the LNCaP prostate cancer cell line. _Prostate_ 2004; 58: 130–144. Article  CAS  Google Scholar  * Bonkhoff H, Stein U, Aumüller G, Remberger K . Differential expression of 5α-reductase isoenzymes in the human prostate and prostatic carcinomas. _Prostate_ 1996; 29: 261–267. Article  CAS  Google Scholar  * Festuccia C, Angeluzzi A, Gravina GL, Muzi P, Vicentini C, Bologna M . Effects of 5α-reductase inhibitors on androgen-dependent human prostatic carcinoma cells. _J Cancer Res Clin Oncol_ 2005; 131: 243–254. Article  CAS  Google Scholar  * Nishiyama T, Hashimoto Y, Takahashi K . The influence of androgen deprivation therapy on dihydrotestosterone levels in the prostatic tissue of patients with prostate cancer. _Clin Cancer Res_ 2004; 10: 7121–7126. Article  CAS  Google Scholar  * Mohler JL, Gregory CW, Ford III OH, Kim D, Weaver CM, Petrusz P _et al_. The androgen axis in recurrent cancer. _Clin Cancer Res_ 2004; 10: 440–448. Article  CAS  Google Scholar  * Titus MA, Schell MJ, Lih FB, Tomer KB, Mohler JL . Testosterone and dihydrotestosterone tissue levels in recurrent prostate cancer. _Clin Cancer Res_ 2005; 11: 4653–4657. Article  CAS  Google Scholar  * Page ST, Lin DW, Mostaghel EA, Dess DL, True LD, Amory JK _et al_. Persistent intraprostatic androgen concentrations after medical castration in healthy med. _J Clin Endocrinol Metab_ 2006; 91: 3050–3058. Google Scholar  * Titus MA, Gregory CW, Ford III OH, Schell MJ, Maygarden SJ, Mohler JL . Steroid 5α-reductase isozymes I and II in recurrent prostate cancer. _Clin Cancer Res_ 2005; 11: 4365–4371. 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Article  Google Scholar  * Fleshner N, Gomella LG, Cookson MS, Finelli A, Evans A, Taneja S _et al_. Delay in the progression of low-risk prostate cancer: rationale and design of the Reduction by Dutasteride of Clinical Progression Events in Expectant Management (REDEEM) trial. _Contemp Clin Trials_ 2007; 28: 763–769. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * St. Theresienkrankenhaus, Nürnberg, Germany J Dörsam * Urologische Abteilung, Chirurgische Klinik, München-Bogenhausen, Germany J Altwein Authors * J Dörsam View author publications You can also search for this author inPubMed Google Scholar * J Altwein View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to J Dörsam. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Dörsam, J., Altwein, J. 5α-Reductase inhibitor treatment of prostatic diseases: background and practical implications. _Prostate Cancer Prostatic Dis_ 12, 130–136 (2009). https://doi.org/10.1038/pcan.2008.56 Download citation * Received: 16 June 2008 * Revised: 15 September 2008 * Accepted: 08 October 2008 * Published: 25 November 2008 * Issue Date: June 2009 * DOI: https://doi.org/10.1038/pcan.2008.56 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * benign prostatic hyperplasia * prostate cancer * 5α-reductase * chemoprevention

ABSTRACT This literature review discusses the theoretical background of 5α-reductase inhibitor (5ARI) treatment and the resulting clinical implications. A Medline-based search for


peer-reviewed articles addressing 5ARIs, benign prostatic hyperplasia and prostate cancer was performed. The 5ARIs Finasteride and Dutasteride, which specifically inhibit the production of


dihydrotestosterone by acting as competitive inhibitors of 5α-reductase, are clinically well tolerated and represent an effective treatment option for benign prostatic obstruction.


Finasteride is the first compound which has a proven efficacy in chemoprevention of prostate cancer. The aim of this review was to elucidate, if there are sufficient data available to point


out clinically relevant differences between the drugs. Both compounds achieve a significant reduction of prostate volume, an improvement of symptoms and a lower risk of acute urinary


retention. Whether the different pharmacokinetic and pharmacodynamic properties of Finasteride and Dutasteride are of clinical importance cannot be judged at this time. Access through your


institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 4 print


issues and online access $259.00 per year only $64.75 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to


local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT


BEING VIEWED BY OTHERS THE POST-FINASTERIDE SYNDROME: POSSIBLE ETIOLOGICAL MECHANISMS AND SYMPTOMS Article 11 September 2023 PSA RESPONSE TO ANTIANDROGEN WITHDRAWAL: A SYSTEMATIC REVIEW AND


META-ANALYSIS Article 18 February 2021 SAFETY PROFILE OF DAROLUTAMIDE VERSUS PLACEBO: A SYSTEMATIC REVIEW AND META-ANALYSIS Article 14 December 2023 REFERENCES * Roehrborn CG, Lukkarinen O,


Mark S, Siami P, Ramsdell N, Zinner N . Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5α-reductase inhibitor dutasteride: results of 4-year


studies. _BJU Int_ 2005; 96: 572–577. Article  Google Scholar  * Russel DW, Wilson JD . Steroid 5α-reductase: two genes, two enzymes. _Annu Rev Biochem_ 1994; 63: 25–61. Article  Google


Scholar  * Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD . The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. _J Urol_ 1993; 150: 379–385.


Article  CAS  Google Scholar  * Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C _et al_. Cancer statistics 2006. _Ca Cancer J Clin_ 2006; 56: 106–130. Article  Google Scholar  * Iehle


C, Radvanyi F, Gil Diez de Medina S, Ouafik LH, Gérard H, Chopin D _et al_. Differences in steroid 5α-reductase isoenzyme expression between normal and pathological human prostate tissue. _J


Steroid Biochem Mol Biol_ 1999; 68: 189–195. Article  CAS  Google Scholar  * Andriole G, Bruchovsky N, Chung LWK, Matsumoto AM, Rittmaster R, Roehrborn C _et al_. Dihydrotestosterone and


the prostate: the scientific rationale for 5α-reductase inhibitors in the treatment of benign prostatic hyperplasia. _J Urol_ 2004; 172: 1399–1403. Article  CAS  Google Scholar  * Le H,


Arnold JT, McFann KK, Blackmann MR . DHT and testosterone but not DHEA or E2 differentially modulate IGF-I, IGFBP-3 in human prostatic stromal cells. _Am J Physiol Endocrinol Metab_ 2006;


290: E952–E960. Article  CAS  Google Scholar  * Thomas LN, Douglas RC, Vessey JP, Gupta R, Fontaine D, Norman RW _et al_. 5α-Reduction type 1 immunostaining is enhanced in some prostate


cancers compared with BPH epithelium. _J Urol_ 2003; 170: 2019–2025. Article  CAS  Google Scholar  * Thomas LH, Lazier CB, Gupta R, Norman RW, Thompson IM, Troyer DA _et al_. Differential


alterations in 5α-reductase type 1 and type 2 levels during development and progression of prostatae cancer. _Prostate_ 2004; 58: 1–9. Article  Google Scholar  * Luo J, Dunn TA, Ewing CM,


Walsh PC, Isaacs WB . Decreased gene expression of steroid 5α-reductase 2 in human prostate cancer: implication for finasteride therapy of prostate carcinoma. _Prostate_ 2003; 57: 134–139.


Article  CAS  Google Scholar  * Walsh PC, Madden JD, Harrod MJ, Goldstein JL, MacDonald PC, Wilson JD . Familial incomplete male pseudohermaphroditism type 2. Decreased DHT formation in


pseudovaginal, perineoscrotal hypospadias. _N Engl J Med_ 1974; 291: 944–949. Article  CAS  Google Scholar  * Steers WD . 5α-Reductase activity in the prostate. _Urology_ 2001; 58 (Suppl 1):


17–24. Article  CAS  Google Scholar  * Evans HC, Goa KL . Dutasteride. _Drugs Aging_ 2003; 20: 905–916. Article  CAS  Google Scholar  * Frye SV . Discovery and clinical development of


dutasteride, a potent dual 5α-reductase inhibitor. _Curr Top Med Chem_ 2006; 6: 405–421. Article  CAS  Google Scholar  * Steiner JF . Clinical pharmacokinetics and pharacodynamics of


finasteride. _Clin Pharmacokinet_ 1996; 30: 16–27. Article  CAS  Google Scholar  * Clark RV, Hermann DJ, Cunnungham GR, Wilson TH, Morril BB, Hobbs S . Marked suppression of DHT in men with


benign prostatic hyperplasia by dutasteride, a dual 5α-reductase inhibitor. _J Clin Endocrinol Metab_ 2004; 89: 2179–2184. Article  CAS  Google Scholar  * Marks LS, Roehrborn CG, Rittmaster


RS . Duration of DHT suppression following discontinuation of dutasteride: implication for missed doses. _J Urol_ 2004; 171: 242–243. Article  Google Scholar  * Andriole GL, Guess HA,


Epstein JI, Wise H, Kadman D, Crawford ED _et al_. Treatment with finasteride preserves usefulness of PSA in the detection of prostate cancer: results of a randomized, double-blind,


placebo-controlled clinical trial. _Urology_ 1998; 52: 195–202. Article  CAS  Google Scholar  * Andriole GL, Marberger M, Roehrborn CG . Clinical usefulness of serum PSA for the detection of


prostate cancer is preserved in men receiving the dual 5α-reductase inhibitor dutasteride. _J Urol_ 2006; 175: 1657–1662. Article  CAS  Google Scholar  * Debruyne F, Barkin J, van Erps P,


Reis M, Tammela TMJ, Roehrborn CG . Efficacy and safety of long-term treatment with the dual 5α-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. _Eur


Urol_ 2004; 45: 488–495. Article  Google Scholar  * Marks LS, Roehrborn CG, Andriole GL . Prevention of benign prostatic hyperplasia disease. _J Urol_ 2006; 176: 1299–1306. Article  Google


Scholar  * Roehrborn CG, Boyle P, Gould AI, Waldstreicher J . Serum PSA as a predictor of prostate volume in men with benign prostatic hyperplasia. _Urology_ 1999; 53: 581–589. Article  CAS


  Google Scholar  * Roehrborn CG . The potential of serum PSA as a predictor of clinical response in patients with lower urinary tract symptoms and benign prostatic hyperplasia. _BJU Int_


2004; 93 (Suppl 1): 21–26. Article  Google Scholar  * Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH _et al_. Serum PSA is a strong predictor of future prostate


growth in men with prostatic hyperplasia. Proscar long-term efficacy and safety study. _J Urol_ 2000; 163: 13–20. Article  CAS  Google Scholar  * Roehrborn CG, Boyle P, Nickel JC . PSA is a


significant predictor of objective parameters in men at risk for BPH progression. _J Urol_ 2003; 169: A1362. Article  Google Scholar  * McConnell JD, Brushkewitz R, Walsh PC, Andriole G,


Lieber M, Holtgrewe HL _et al_. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride


long-term efficacy and safety study group. _N Engl J Med_ 1998; 338: 557–563. Article  CAS  Google Scholar  * Roehrborn CG, Marks LS, Fenter T, Freedman S, Tuttle J, Gittleman M _et al_.


Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. _Urology_ 2004; 63: 709–715. Article  Google Scholar  * Marberger M, Roehrborn CG,


Marks LS, Wilson T, Rittmater RS . Relationship among serum testosterone, sexual function and response to treatment in men receiving dutasteride for BPH. _J Clin Endocrinol Metab_ 2006; 91:


1323–1328. Article  CAS  Google Scholar  * Slawin KM, Kattan MW, Roehrborn CG, Wilson T . Development of nomogram to predict acute urinary retention or surgical intervention, with or without


dutasteride therapy, in men with BPH. _Urology_ 2006; 67: 84–88. Article  Google Scholar  * Nickel JC . Comparison of clinical trials with finasteride and dutasteride. _Rev Urol_ 2004; 6


(Suppl 9): S31–S39. PubMed  PubMed Central  Google Scholar  * Hagerty JA, Ginsberg PC, Metro MJ, Harkaway RC . A prospective, comparative study of the onset of symptomatic benefit of


dutasteride versus finasteride in men with BPH in clinical practice. _J Urol_ 2004; 171: 356–359. Article  Google Scholar  * McConnell JD, Roehrborn CG, Bautista OM, Andriole Jr GL, Dixon


CM, Kusek JW _et al_. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of BPH. _N Engl J Med_ 2003; 349: 2387–2398. Article  CAS  Google


Scholar  * Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR _et al_. Combination therapy with doxazosin and finasteride for BPH in patients with lower urinary tract


symptoms and a baseline total prostate volume of 25 ml or greater. _J Urol_ 2006; 175: 217–224. Article  CAS  Google Scholar  * Barkin J, Guimaraes M, Jacobi G, Pushkar D, Taylor S, van


Vierssen Trip OB . SMART-1: α-blocker therapy can be withdrawn in the majority of men following initial combination therapy with dual 5α-reductase inhibitor dutasteride. _Eur Urol_ 2003; 44:


461–466. Article  CAS  Google Scholar  * Speakman M, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F _et al_. Integrating risk profiles for disease progression in the


treatment choice for patients with lower urinary tract symptoms/BPH: a combined analysis of external evidence and clinical expertise. _Prostate Cancer Prostatic Dis_ 2005; 8: 369–375.


Article  CAS  Google Scholar  * Kelloff GJ, Lippman SM, Dannenberg AJ, Sigman CC, Pearce HL, Reid BJ _et al_. Progress in chemoprevention drug development: the promise of molecular


biomarkers for prevention of intraepithelial neoplasia and cancer—a plan to move forward. _Clin Cancer Res_ 2006; 12: 3661–3697. Article  CAS  Google Scholar  * Thompson IM, Goodman J,


Tangen CM, Lucia MS, Miller GJ, Ford LG _et al_. The influence of finasteride on the development of prostate cancer. _N Engl J Med_ 2003; 349: 215–224. Article  CAS  Google Scholar  * Klein


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_Contemp Clin Trials_ 2007; 28: 763–769. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * St. Theresienkrankenhaus, Nürnberg, Germany J Dörsam


* Urologische Abteilung, Chirurgische Klinik, München-Bogenhausen, Germany J Altwein Authors * J Dörsam View author publications You can also search for this author inPubMed Google Scholar *


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permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Dörsam, J., Altwein, J. 5α-Reductase inhibitor treatment of prostatic diseases: background and practical implications. _Prostate Cancer


Prostatic Dis_ 12, 130–136 (2009). https://doi.org/10.1038/pcan.2008.56 Download citation * Received: 16 June 2008 * Revised: 15 September 2008 * Accepted: 08 October 2008 * Published: 25


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hyperplasia * prostate cancer * 5α-reductase * chemoprevention