Current Status of 5alpha-Reductase Inhibitors in Prostate Disease Management.
10.4111/kju.2013.54.4.213
- Author:
Dong Il KANG
1
;
Jae Il CHUNG
Author Information
1. Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. prosdoc@hanmail.net
- Publication Type:Review
- Keywords:
5-alpha reductase inhibitor;
Hemospermia;
Prostatic hyperplasia;
Prostate neoplasms
- MeSH:
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
- From:Korean Journal of Urology
2013;54(4):213-219
- CountryRepublic of Korea
- Language:English
-
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.
