Elizabeth Fasy
September 27, 1996
55 year old black male presents with complaints of decreased force of his urinary stream,hesitancy and nocturia with a normal digital rectal exam, and he wants to know if there is any one medication that would safely relieve his symptoms of BPH.
* Terazosin was found to be more effective than finasteride in terms of decreasing symptom scores and increasing urinary flow rates.
* The combination of terazosin and finasteride was found to be no more effective that terazosin alone.
* Prospective double-blind, placebo controlled study of 1229 men, ages 45-80 years old, with symptomatic BPH without prior treatment or comorbid conditions randomized in equal proportions to receive terazosin and finasteride placebo, finasteride and terazosin placebo,both terazosin and finasteride, and terazosin and finasteride placebos for one year.
Mean change at 52 weeks Placebo Finasteride Terazosin Combination Tx p value Symptom Scores 2.6 points 3.2 6.1 6.2 <0.001 Peak UFR 1.4 ml/sec 1.6 2.7 3.2 <0.001 Prostatic Volume +0.5 -6.1 +0.5 -7.0 <0.001 PSA -0.1 ng/ml +0.9 -0.4 +0.9 <0.001 "Number Needed to Harm" (Number needed to experience adverse effects): Terazosin Finasteride Dizziness 5.3 100 Asthenia 14 infinity
* Impressive large randomized double blinded study with all patients accounted for and treated equally.
* Treatment effect difficult to quantitate due to the lack of numerical data.
* Generalizable to US population with 21% African-Americans, but not as generalizable to
our UNC resident clinic population.
* No threshold level of prostate enlargement was required for entry into this study as compared with previous studies of finasteride where men with larger prostates were found to have statistically significant symptomatic improvement and increased urinary flow rates.
* It is unclear whether ongoing growth of the prostate or tachyphylaxis will lead to deterioration
of symptom improvement overtime using alpha-adrenergic antagonists.
* It remains to be seen whether medical therapy will ultimately reduce the need for surgical
intervention.References:
1. Lepor, et al. The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia.
NEJM,1996;335, 533-539.
2. Gormley, et al. The Effect of Finasteride in Men with Benign Prostatic Hyperplasia. NEJM, 1992;
327, 1186-1191.