The latest in clinical trial results of 5-alpha reductase inhibitors in combination regimens for benign prostatic hyperplasia
Kapriniotis K. Manolitsis I. Juliebo-Jones P. Pietropaolo A. Tsaturyan A. Tonyali S. Sener E. Emiliani E. Talyshinskii A. Karagiotis T. Somani B. Tzelves L.
2025Taylor and Francis Ltd.
Expert Opinion on Pharmacotherapy
2025#26Issue 3301 - 311 pp.
Introduction: BPH/male LUTS is a prevalent condition in the aging male population with multifactorial pathophysiology. Pharmacotherapy remains the cornerstone of treatment in patients who fail conservative treatment. 5-α-Reductase inhibitors (5-ARIs) are the only class of medication shown to reduce the risk of acute retention and BPH-related surgery and, thus, are commonly used along with other “short acting” medications in combination treatments. Areas covered: Combination treatments with α-blockers and 5-ARIs have been investigated extensively in high quality trials that prove the long-term efficacy of such treatments with acceptable rates of side effects. Combination treatments involving 5-ARIs and other classes of medications (anticholinergics, b3 agonists, PDEI) have been shown to be beneficial in the short term and but studies with longer follow-up periods are required to fully establish their role. Expert opinion: A-blocker/5-ARI combination treatment is a reasonable approach for patients with male LUTS/BPH who are at increased risk of disease progression or have incomplete response to monotherapies. Other combination treatments with 5-ARIs and PDEI or anticholinergics/β-3 agonists can be tried based on predominant symptoms or side effect profile, but patients should be informed about the lack of long-term data.
5-ARI , anticholinergic , BPH , male LUTS , PDEI , α-blocker , β-3 agonist
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Department of Urology, Whipps Cross Hospital, London, United Kingdom
Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Department of Urology, Haukeland University Hospital, Bergen, Norway
European Association of Urology-Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group, Arnhem, Netherlands
Urology Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Department of Urology, Erebouni Medical Center, Yerevan, Armenia
Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
Department of Urology, Fundació Puigvert, Barcelona, Spain
Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
Department of Urology
Department of Urology
Department of Urology
European Association of Urology-Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group
Urology Department
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology and Andrology
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