Finasteride in the treatment of benign prostatic hypertrophy: an update - New indications for Finasteride therapy

A phenomenon of the prostate gland, which is also shared by hair follicles, is that it is little influenced by testosterone (T) for androgenic stimula tion, but instead by its metabolite 5 alpha-dihydrotestasterone (DHT). By b locking the conversion of T to DHT, the circulating level of DHT is reduced by 80%, the size: of the prostate gland is reduced by about 20% and the le vel of prostate-specific antigen (PSA) by about 50%. Treatment of patients with obstructive benign prostatic hypertrophy (BPH) with the drug Finasteri de leads to a moderately improved urinary flow, symptomatic improvement and halts the natural progress of the disease. Since DHT potentiates the effec t of testosterone on erectile function, the side-effects are impotence in 3 % of patients, decreased ejaculatory volume, and gynaecomastia in 0.4% of p atients. The drug could be regarded as a safe way to treat moderately sympt omatic BPH. The efficacy of the drug is long-lasting (more than 7 years). I t has also been tried in prostate cancer, but is less effective. It reduces PSA levels by 50% and, in combination therapy, therefore, PSA levels remai n low for longer when Finasteride is added. An important finding is the eff icacy of Finasteride treatment in haematuria from BPH. The drug interacts w ith vascular endothelium growth factor and efficiently prevents new bleedin g. It could be regarded as a first-line therapy for this type of haematuria . Finasteride can also be used to stop male baldness. It seems particularly effective in men aged 20-40 years; 85% of patients stopped losing hair whe n given Finasteride. When the treatment was stopped hair loss continued, th us therapy may have to be "lifelong".