Combination of α-blocker and 5α-reductase inhibitor for treatment of benign prostatic hyperplasia

Deying Kang, Caoyang Hu, Yanyan Fu, Dongwen Wang


Purpose: This study compared the efficacy of an α-blocker monotherapy alone with a combination of α-blocker plus 5α-reductase in treatment of benign prostatic hyperplasia (BPH).

Methods: Medline (PubMed), EMBASE, CENTRAL (Cochrane databases) and Google Scholar were searched until May 2015 using the following search terms: ([α-blocker] AND 5α-reductase inhibitor) AND benign prostatic hyperplasia; and benign prostatic hyperplasia AND (adrenergic alpha blockers OR 5 alpha reductase inhibitor). Randomized controlled trials (RCTs) that included men with a clinical diagnosis of BPH were included. Eligible studies had to have an intervention group that received combination therapy (5α reductase inhibitor plus α-blocker) and a control group that received only α-blocker. Quality assessment and sensitivity analysis were performed.

Results: Six studies were included. Combination therapy was found to significantly reduce urinary retention incidence rate (OR=0.286, 95%CI: 0.199 - 0.412, P<0.001) and lower the risk of surgical treatment (OR=0.277, 95%CI: 0.20- 0.384, P<0.001), and to result in a greater reduction in prostate volume (mean difference =-7.387, 95%CI: -12.982 to -1.791, P=0.010) and larger increase in maximal urinary flow rate (mean difference = 0.527, 95%CI: 0.052 - 1.003, P=0.030) compared with monotherapy. The two treatments were similar with respect to improvement in the International Prostate Symptom Score (IPSS) (mean difference = -0.087, 95%CI: = -0.231 to 0.058, P=0.239). Sensitivity analysis indicated that no one study overly influenced the findings and that the findings are robust. Quality analysis indicated the included studies were of good quality.

Conclusion: These findings indicate that combined α-blocker plus 5α-reductase therapy is more beneficial in treating benign prostatic hyperplasia in contrast to α-blocker monotherapy.

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