Korean J Urol.  2013 Apr;54(4):213-219.

Current Status of 5alpha-Reductase Inhibitors in Prostate Disease Management

• Kang DI
• Chung JI

Abstract

The key enzyme in the androgen synthesis and androgen receptor pathways is 5alpha-reductase (5-AR), which occurs as three isoenzymes. Types I and II 5-ARs the most important clinically, and two different 5-AR inhibitors (5-ARIs), finasteride and dutasteride, have been developed. Several urology associations have recommended and upgraded the use of 5-ARIs for an enlarged prostate with lower urinary tract symptoms. In the Prostate Cancer Prevention Trial and the Reduction by Dutasteride of Prostate Cancer Events Trial, 5-ARIs reduced the incidence of low-grade prostate cancer. However, despite the documented reductions in the overall incidence of prostate cancer, 5-ARIs are at the center of a dispute. The American Society of Clinical Oncology (ASCO) and the American Urology Association (AUA) presented clinical guidelines for the use of 5-ARIs for chemoprevention of prostate cancer in 2008. However, ASCO/AUA has eliminated these from the main "Clinical Guidelines" in 2012, because the U.S. Food and Drug Administration denied a supplemental New Drug Application for the use of dutasteride for prostate cancer chemoprevention. The 5-ARIs can also be used to manage hemospermia and prostatic hematuria, and to prevent intraoperative bleeding, although there is insufficient evidence for a standard strategy. This review summarizes the current use of 5-ARIs for prostate disease, including benign prostate hyperplasia, prostate cancer, prostate-related bleeding, and hemospermia.

Keyword

5-alpha reductase inhibitor; Hemospermia; Prostatic hyperplasia; Prostate neoplasms

MeSH Terms

Azasteroids
Chemoprevention
Disease Management
Dissent and Disputes
Finasteride
Hematuria
Hemorrhage
Hemospermia
Hyperplasia
Incidence
Isoenzymes
Lower Urinary Tract Symptoms
Medical Oncology
Prostate
Prostatic Hyperplasia
Prostatic Neoplasms
Receptors, Androgen
United States Food and Drug Administration
Urology
Dutasteride
Azasteroids
Finasteride
Isoenzymes
Receptors, Androgen

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