Department of Urology, University of Thessaly, 6-8, Feidiou Street, 41221 Larissa, Greece.
World J Urol. 2010 Feb;28(1):9-15. doi: 10.1007/s00345-009-0493-y. Epub 2009 Dec 3.
Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS in terms of symptoms and urinary flow, but also to identify those patients at a risk of unfavorable disease progression and to optimize their management. This article reviews the current status of therapy with 5alpha-reductase inhibitors (5ARIs), namely fiasteride and dutasteride, for men with LUTS and BPH.
Data from key randomized controlled trials (Oxford level 1b) on the use of 5ARIs are analyzed.
The efficacy of 5ARIs either as monotherapy or in combination with alpha(1)-adrenoceptor antagonists in the management of LUTS and the impact of monotherapy and combined therapy on BPH progression are discussed. Further promises, including the withdrawal of the alpha-blocker from the combined medical treatment and the potential clinical implications from the use of 5ARIs for prostate cancer chemoprevention in patients receiving 5ARIs for symptomatic BPH are highlighted.
Current evidence shows that 5ARIs are effective in treating LUTS and preventing disease progression and represent a recommended option in treatment guidelines for men who have moderate to severe LUTS and enlarged prostates.
良性前列腺增生（BPH）是一种进行性疾病，常伴有恼人的下尿路症状（LUTS），并可能导致并发症，如急性尿潴留和与 BPH 相关的手术。因此，BPH 治疗的目标不仅是改善 LUTS 的症状和尿流，还要识别那些有不利疾病进展风险的患者，并优化其管理。本文综述了 5α-还原酶抑制剂（5ARIs），即非那雄胺和度他雄胺，在治疗有 LUTS 和 BPH 的男性中的治疗现状。
分析了关键的随机对照试验（牛津水平 1b）中关于使用 5ARIs 的数据。
讨论了 5ARIs 作为单一疗法或与 α1-肾上腺素能受体拮抗剂联合治疗 LUTS 的疗效，以及单一疗法和联合疗法对 BPH 进展的影响。强调了进一步的前景，包括从联合药物治疗中撤出 α-阻滞剂，以及在接受 5ARIs 治疗有症状的 BPH 的患者中使用 5ARIs 进行前列腺癌化学预防的潜在临床意义。
现有证据表明，5ARIs 可有效治疗 LUTS 和预防疾病进展，是治疗有中度至重度 LUTS 和前列腺增大的男性的推荐选择。
