Department of Urology, Severance Hospital.
Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Curr Opin Urol. 2018 May;28(3):288-293. doi: 10.1097/MOU.0000000000000497.
The use of 5-alpha reductase inhibitors (5ARIs) for the treatment of benign prostatic hyperplasia (BPH) and other diseases has been proposed and studied. However, the controversy about its benefits and harms for other diseases has persisted. In this review, we will discuss the newly identified effects of 5ARIs based on recently published studies.
These drugs are currently recommended in clinical guidelines for BPH. However, the reporting of adverse effects, including sexual dysfunction as well as neurologic, endocrine, and cardiovascular effects, have been controversial. There are reports of additional effects of 5ARI in prostate cancer and bladder cancer. Although 5ARIs have been prescribed for the treatment of androgenic alopecia (AGA), postfinasteride syndrome can result, with symptoms that range from sexual dysfunction to muscle atrophy.
Clinical applications of 5ARIs have been established for the treatment of BPH and AGA from a series of randomized controlled trials. The adverse effects of 5ARIs affect only a small proportion of treated patients and can be resolved with discontinued treatment. It will be necessary to establish the mechanism by which 5ARIs elicit these effects through better designed studies.
目的综述：5α-还原酶抑制剂（5ARIs）已被提议并研究用于治疗良性前列腺增生（BPH）和其他疾病。然而，关于其对其他疾病的益处和危害的争议仍在持续。在这篇综述中，我们将根据最近发表的研究讨论新发现的 5ARIs 的作用。
最新发现：这些药物目前被临床指南推荐用于 BPH 的治疗。然而，关于不良反应的报告，包括性功能障碍以及神经、内分泌和心血管方面的影响，一直存在争议。也有报告称 5ARI 在前列腺癌和膀胱癌中有额外的作用。虽然 5ARIs 已被用于治疗雄激素性脱发（AGA），但会导致 Postfinasteride 综合征，症状范围从性功能障碍到肌肉萎缩。
总结：一系列随机对照试验确立了 5ARIs 治疗 BPH 和 AGA 的临床应用。5ARIs 的不良反应仅影响一小部分接受治疗的患者，并且可以通过停止治疗来解决。通过更好设计的研究来确定 5ARIs 产生这些作用的机制将是必要的。
