Alpha-blockade for BPH can be discontinued in some cases


WESTPORT, CT (Reuters Health) – Alpha-blocker/finasteride combination therapy effectively controls benign prostatic hyperplasia (BPH) symptoms, but a report published in the August issue of Urology suggests that the alpha-blocker can be discontinued in some men if combination therapy is effective.

An alpha-blocker is often added to finasteride for the treatment of symptomatic BPH, because the latter medication can take several months to work. While many urologists may be hesitant to tamper with an effective combination therapy, the current report suggests one way of simplifying therapy and reducing the cost.

Dr. Richard C. Harkaway, from Albert Einstein Medical Center in Philadelphia, and colleagues evaluated the symptoms of 272 men with BPH who had doxazosin discontinued after being effectively treated with doxazosin and finasteride. The men had prostate sizes greater than 40 g and American Urological Association symptom scores greater than 20.

The men were divided into groups based on the doxazosin dose received (2, 4 or 8 mg/day) and the duration of doxazosin therapy (3, 6, 9 or 12 months). The researchers defined successful discontinuation as no increase in symptom score and no desire to restart doxazosin.

The success rate was directly associated with the duration of doxazosin therapy. A success rate of at least 73% was achieved when 9 or more months of therapy had been given, the authors note.

"Patients with moderate to severe lower urinary tract symptoms and moderately enlarged prostates initially receiving combination therapy using finasteride and an alpha-blocker are likely to experience no significant symptom deterioration after discontinuation of the alpha-blocker after 9 to 12 months of combination therapy, regardless of the dose of the alpha-blocker chosen," the authors conclude.

In a related editorial, Dr. Herbert Lepor, from New York University Medical Center, comments that "there are several fundamental problems" with the current study. In addition, he notes that the major finding from the "present uncontrolled study is inconsistent with the published data and is also counterintuitive."

Dr. Lepor states that "it seems as though the poorly designed study was conceived to show the lack of long-term benefit of doxazosin."

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