Health and Prostate

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Finasteride versus Terazosin for Benign Prostatic Hyperplasia

Results from a large clinical trial comparing the 5-alpha-reductase inhibitor finasteride with the alpha1-blocker terazosin for benign prostatic hyperplasia suggest that terazosin is the more effective of the two drugs. Abbott and Merck co-sponsored the 1-year study, which involved 1229 men randomly assigned to either finasteride, terazosin, a combination of the two, or placebo. Herbert Lepor (Chief of Urology at New York University Medical Center) reported the results at a recent meeting of the American Urological Association in Orlando, FL. Lepor said that finasteride was no more effective for reducing symptoms than placebo, whereas terazosin was significantly more effective than either finasteride or placebo. Only patients with large prostate glands that are nonresponsive to alpha1-blockade should be treated with finasteride, according to Lepor.

The report included an analysis of placebo-controlled trials as well as the comparison trial, comprising data on 2500 patients. Merck researchers responded that the size of the prostate gland in study participants (about 36 gm) was unusually small for a diagnosis of benign prostatic hyperplasia. Finasteride is most effective in men whose prostates weigh more than 40 gm (about half of men with BPH). The prostate normally weighs about 20 gm until a man reaches 40 years of age. Determining the relative efficacy of finasteride versus alpha1-blockers awaits the results of additional clinical trials. Currently, three studies are under way: an American trial of terazosin versus finasteride, a European trial of doxazosin versus finasteride, and a 5-year American trial of doxazosin versus finasteride. (American Urological Association meeting in Orlando, FL, 1996.)

Treating Benign Prostatic Hyperplasia with Microwaves

The first nonsurgical device for the treatment of benign prostatic hyperplasia has been approved by the FDA. This device – the Prostatron (produced by EDAP Technomed, Cambridge, MA) – uses microwaves to heat and destroy prostate tissue blocking the urethra. The Prostatron has a catheter that is inserted through the urethra to the prostate. The tip of the catheter acts as an antenna that emits microwaves to heat the tissue. Water circulates through the catheter applicator to cool the system and protect adjacent tissue. Although the Prostatron does not correct all problems (such as incomplete emptying of the bladder), the device is nevertheless an effective and convenient alternative to drug therapy (which provides only partial relief) and surgery (which is associated with complications such as impotence). Men with benign prostatic hyperplasia can be treated in about an hour in an outpatient setting. In European and American multicenter clinical trials involving 375 men with BPH, 75% reported symptomatic relief. Improvement was sustained in about half the patients at 4-year follow-up; however, the rest had to repeat the procedure or resort to drug therapy or surgery. (Information is available from the manufacturer.)

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