Elsevier

Urology

Volume 58, Issue 2, August 2001, Pages 203-208
Urology

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

https://doi.org/10.1016/S0090-4295(01)01201-8Get rights and content

Abstract

Objectives. To determine the effect of discontinuation of alpha-blockade and 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 40 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 and 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 doxazosin in an additional 60 patients. We discontinued doxazosin at 3, 6, 9, or 12 months, while continuing finasteride, and then re-evaluated the patients 1 month later to determine whether any worsening of symptoms had resulted.

Results. In patients discontinuing doxazosin at 3 months, success (defined as no increase in symptom score and no desire to resume doxazosin) was reported 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 discontinuing doxazosin at 9 months, success was reported by 84%, 80%, and 73% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 12 months, success was reported by 84%, 85%, and 87% of those taking 2, 4, and 8 mg, respectively.

Conclusions. Patients with 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 discontinuing the alpha-blocker after 9 to 12 months of combination therapy regardless of the dose of alpha-blocker chosen.

Section snippets

Material and methods

Between June 1997 and June 1999, 272 men with an average age of 66 years were enrolled in this study. These men had prostates of 40 g or larger (average weight 54 g, range 40 to 104 g), American Urological Association (AUA) symptom scores of 20 or greater (range 20 to 33), and prostate-specific antigen levels of less than 4.0 ng/mL (or a prostate-specific antigen level between 4 and 10 ng/mL with a prostate biopsy negative for malignancy). The prostate size was measured by digital rectal

Results

Of the 272 men enrolled in this study, 240 reported a favorable response (defined as no increase in symptom score and toleration of study medications) to the initial combination regimen (5 mg finasteride and 2, 4, or 8 mg doxazosin) after 1 month. Of the 32 men who did not continue with the study, 11 reported no improvement in symptom score and 21 did not tolerate the study medications. The most frequent side effects were dizziness and orthostatic hypotension. In the patients discontinuing

Comment

Even though combination therapy is a popular treatment modality among urologists, there is a surprising lack of published reports on the subject. The Veterans Affairs study by Lepor et al.9 in 1996 is perhaps the most widely publicized. In their 1-year study, 1229 men with symptoms of bladder outlet obstruction were randomized to a placebo, finasteride, terazosin, or a combination of finasteride and terazosin. Lepor et al. concluded that terazosin alone was an effective treatment strategy,

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