Discontinuation of alpha-blockade after initial treatment with finasterideand doxazosin in men with lower urinary tract symptoms and clinical evidence of benign prostatic hyperplasia

Objectives. To determine the effect of discontinuation of alpha-blockade an d continuation of finasteride in men with lower urinary tract symptoms and enlarged prostates receiving combination treatment and to determine whether the alpha-blocker dose influences the ability to discontinue it. Methods. We treated 272 consecutive men with a prostate size greater than 4 0 g and American Urological Association symptom score greater than 20 with 5 mg finasteride and 2 mg doxazosin daily. Two hundred forty men reported a favorable response to therapy, defined as any reduction in symptom score a nd toleration of the medications. The dose was maintained at 2 mg doxazosin in 100 men and was titrated to 4 mg doxazosin in 80 patients and to 8 mg d oxazosin in an additional 60 patients. We discontinued doxazosin at 3, 6, 9 , or 12 months, while continuing finasteride, and then re-evaluated the pat ients 1 month later to determine whether any worsening of symptoms had resu lted. Results. In patients discontinuing doxazosin at 3 months, success (defined as no increase in symptom score and no desire to resume doxazosin) was repo rted by 20%, 15%, and 13% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 6 months, success was reported by 48%, 45%, and 40% of those taking 2, 4, and 8 mg, respectively. In patients disc ontinuing doxazosin at 9 months, success was reported by 84%, 80%, and 73% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing dox azosin at 12 months, success was reported by 84%, 85%, and 87% of those tak ing 2, 4, and 8 mg, respectively. Conclusions. Patients with lower urinary tract symptoms and moderately enla rged prostates initially receiving combination therapy using finasteride an d an alpha-blocker are likely to experience no significant symptom deterior ation after discontinuing the alpha-blocker after 9 to 12 months of combina tion therapy regardless of the dose of alpha-blocker chosen. UROLOGY 58: 20 3-209, 2001. (C) 2001, Elsevier Science Inc.