Scheme of treatment of prostate adenoma

Treatment scheme for prostate adenoma

Everything that is once born goes through a period of growth, maturation and decay - this is a typical pattern for all living things, including the human body. The powerful mechanism of reproduction, having fulfilled its function, loses its relevance and gradually turns off. For the female body, the menopause begins. Isn't the male body characterized by age-related changes?

How prostate adenoma develops

What is prostate adenoma

The activation of male hormones during adolescence causes the boy's prostate to increase to a certain size. In an adult sexually mature man, this is one of the most important and actively functioning organs, regardless of lifestyle, alcohol consumption, smoking, and even sexual activity. Young men usually do not know what Prostate adenoma is, like eunuchs. Some doctors even suggested treating this disease by castration - if there is no function, then there is no problem.

In the process of extinction, the uterus and ovaries atrophy in women, and in men, the prostate begins to enlarge, compressing the ureter, making it difficult to urinate. The walls of the bladder begin to strain to push the next portion of urine through the narrowing hole. A constant load first makes the bladder "puffed up", and as the walls thicken, its internal volume decreases.

Over time, muscle tone weakens, turning the bladder into a kind of flabby bag that is unable to expel even a small amount of urine with an increasingly frequent urge to urinate. Moreover, from a crowded bladder, not finding the right way out, urine returns to the kidneys, disrupting their functions.

This happens to every second man after the age of sixty, and by the age of eighty, only 10-15% of men are not familiar with such a disaster.

Who is to blame and what to do?

The problem should be solved by an andrologist

Age-related excessive enlargement of the prostate would be more correct to call BPH - benign prostatic hyperplasia, and not adenoma, and not be considered a disease, but considered a normal process of manifestation of male menopause. Despite the fact that the symptoms lead the patient to a urologist, the problem should be solved by an andrologist, because difficulties with urine output are secondary, and the true cause is the prostate, which grows in response to the changing hormonal balance of the body.

A decrease in the activity of male hormones with an increase in the amount of female hormones is the main reason for the changes that occur with the prostate gland.

The task of the doctor is to detect the imbalance in a timely manner, preventing the consequences, but it is almost impossible to cure either old age or adenoma. It is only in our power to slow down and suspend the inevitability of processes.

An example from medical practice

Dear doctor! You have already answered me about the treatment of prostate adenoma. And the pharmacist answered my question about medicines. From what I understand, there are two types. Help me choose a treatment regimen. Let me remind you that I have a prostate adenoma of the 1st degree. But I would not like to launch it and bring the matter to an operation. Sergey Bashkatov, g

Thank you for your trust. But, unfortunately, not all issues can be solved in absentia. It is possible to correctly assess the patient's condition, the degree of his illness, choose medicines or methods of treatment not only taking into account the underlying disease, but also taking into account concomitant diseases and, possibly, those drugs that are taken for other diseases, only with a face-to-face consultation. In distance counseling, there is a high risk of error, so the possibilities of such counseling are limited. We only help to deal with the disease itself, the features of the course, we give an overview of modern methods of treatment.

Choice of treatment methods

Even the fact that after our communication you will be able to ask the right questions to your specialist is already good. Therefore, I can only give you an overview. More often, treatment is started with drugs from the group of alpha1-adrenergic blockers. With low efficiency, they switch to drugs of the second group - inhibitors of 5-alpha reductase. If there is a high risk of progression, combination therapy is recommended.

The choice of specific drugs may also depend on the presence of concomitant arterial hypertension - then drugs that also have a hypotensive effect are preferable. As for your case, I'm not sure you need any treatment at all right now. You do not notice dysuric symptoms. Obviously, the diagnosis was made only on the basis of a rectal examination, in which a slightly enlarged prostate was found. But it can remain in this state for many years. Then what's the point in pills?

Strategy and tactics

Prostate adenoma treatment

In the absence of problems with potency and urination, the doctor prefers exactly expectant tactics with constant monitoring of the patient using the methods of the most sparing plan. With any treatment regimen, a prerequisite is the observance of a hygienic regimen, the exclusion of hypothermia, a long sitting position, the prevention of constipation and urinary retention.

Recommendations are given not to abuse alcohol, fatty, canned and smoked foods, spices and spices, as well as drinks obtained by fermentation.

Toward evening, you should limit the amount of food and water, as often as possible and take more walks. Before starting medical or surgical treatment, you can try using folk methods, such as pollen, horse chestnut, hazel and alder, as well as nettle and pumpkin seeds. Recipes can be found if desired, and infusions and decoctions can be prepared by taking them regularly and for a long time.

Bee products are especially useful if there is no allergy. They say that it is the beekeepers who are among the few who have no idea about prostate adenoma.

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Modern methods of treatment of prostate adenoma without surgery

BPH (benign prostatic hyperplasia) is a benign tumor in the prostate. To date, there are surgical, minimally invasive and drug treatments for prostate adenoma.

The tactics of therapy are selected on an individual basis. When choosing it, the doctor takes into account the severity of the disease and the size of the tumor. With BPH stage 1-2, it is possible to get by with drug therapy.

If prostate adenoma has moved to stage 2-3, the disease is accompanied by urinary retention and other complications, then surgery is indispensable. There are radical and minimally invasive types of surgery.

What is BPH?

The prostate is an unpaired glandular organ in men. The prostate gland is located under the bladder. The urethra passes through the organ. The prostate is responsible for the normal functioning of the genitourinary system and for the quality of sperm.

Prostate adenoma is a disease in which a benign tumor forms in the area of the glandular organ. According to statistics, the disease most often affects men over 45-50 years old.

This is due to the fact that in adulthood there is a hormonal restructuring of the body. In men, the synthesis of testosterone decreases, and at the same time, the level of estradiol and prolactin increases. It is these hormones, or rather their excess, that provoke hyperplasia of prostate tissues.

The exact causes of the development of BPH are not known to physicians for certain. But doctors suggest that there are a number of predisposing factors to the development of the disease. These factors are chronic prostatitis, poor heredity, diseases of the vascular system, harmful working conditions and poor ecology.

An important aspect is the patient's lifestyle. Men who drink alcohol, move little, smoke, eat unbalanced meals, are more prone to prostate diseases.

Prostate adenoma is asymptomatic in the early stages. In view of this, the disease is often detected in the later stages. You can recognize the disease by the following symptoms:

• Frequent urge to urinate, especially at night.
• The appearance of blood impurities in the urine and semen.
• Feeling of incomplete emptying of the bladder.
• Premature ejaculation.
• Erectile dysfunction. In advanced cases, impotence develops.
• Pain during urination.
• Leaking or incontinence

There are 3 stages of prostate adenoma (compensated, subcompensated, decompensated). By location, a benign tumor is subvesical, intravesical and retrotrigonal.

To make a diagnosis, the patient should undergo a comprehensive differential diagnosis.

Radical prostatectomy

Radical prostatectomy is widely used in surgery. The operation is prescribed for patients suffering from adenoma or prostate cancer. Prostatectomy is performed under general anesthesia.

Before surgery, the patient will need to undergo a second diagnosis, consult with an anesthesiologist, a surgeon. Premedication is mandatory, that is, before the procedure, the patient is prescribed antibiotics and sedatives.

There are several types of prostatectomy:

The essence of the procedure is to remove the prostate gland. In this case, the surgeon tries to preserve the nerve bundle, which is responsible for erectile function and the process of urination. With a timely operation, the prognosis is favorable.

After surgery, the patient will need to stay in the hospital under medical supervision for 7-14 days. The patient is fitted with a Foley catheter, which helps to improve the flow of urine from the bladder.

Also, during the rehabilitation period, the patient should take antibiotics and painkillers. The stitches are removed after about 1-2 weeks. It is recommended to wear a bandage and refrain from physical activity for 1-2 months.

After a prostatectomy, the patient should regularly visit the attending urologist for preventive examinations.

Minimally invasive procedures

Considering modern methods of treating prostate adenoma, one cannot ignore minimally invasive procedures. They will be effective for adenomas of severity 2-3, when the size of the tumor is small.

Minimally invasive procedures have a number of advantages. They are good because they are carried out on an outpatient basis, that is, the patient does not need to go to the hospital. In addition, such surgical interventions are much better tolerated and less likely to cause postoperative complications.

The following are recognized as the most effective methods:

• Laser vaporization. The essence of the procedure is to remove the tumor with a laser. Under the influence of high temperatures, the affected tissues of the prostate gland die off, as a result of which the glandular organ decreases in size. Vaporization is prescribed if the size of the neoplasm is small. The disadvantage of the procedure is its high cost.
• Needle ablation. This modern method of treatment of prostate adenoma began to be practiced recently. What is the point? The doctor inserts a needle through the cystoscope into the prostate tissue. Next, radio waves are fed through the cystoscope, which heats and destroys the affected prostate tissue.
• Cryodestruction. Liquid nitrogen is injected through the cystoscope, which freezes and destroys the affected prostate tissue. The method is bad because during the manipulation it is possible to damage the urethra and nearby internal organs.
• Embolization of the arteries of the prostate. The technique is rarely practiced due to the fact that only a highly qualified surgeon can perform the operation. The essence of embolization is the introduction of spheres of medical plastic into the arteries of the prostate. As a result, the spheres clog the arterioles and prevent the nutrition of the affected prostate cells, as a result of which the neoplasm dies off.

If you believe the feedback from patients, then the best technique is laser vaporization. After the procedure, unpleasant consequences rarely develop - impotence, urinary incontinence, urethral stricture.

It is worth noting that shock wave therapy is not practiced in the treatment of prostate adenoma. The technique is used for chronic prostatitis.

Drug treatment of BPH

Conservative therapy for benign prostatic hyperplasia is carried out only if the size of the neoplasm is small. The basis of therapy is drugs.

In order to prevent tumor growth, 5-alpha reductase inhibitors (Avodart, Proscar, Duodart, Penester) should be taken. The drugs block the enzyme that causes prostate hyperplasia. 5-alpha reductase inhibitors should be used for at least 1-3 months.

To stop the unpleasant symptoms of BPH, you should use alpha-1-blockers (Omnic, Tamsulosin, Omnic Okas, Kardura) and bioregulatory peptides (Vitaprost, Samprost, Prostatilen, Prostatilen Zinc). For the treatment and prevention of the disease, you can additionally use herbal remedies (Prostamol Uno, Prostaplant, Indigal, etc.).

When carrying out therapeutic measures, it is recommended:

With an integrated approach to treatment, it is possible to prevent further tumor growth and stop the unpleasant symptoms of BPH.

Myths about the treatment of prostate adenoma

Truely effective methods of treating prostate adenoma have been discussed above. Now consider the myths and ineffective methods of therapy. Folk remedies are completely ineffective.

Decoctions and tinctures based on celandine, sage and other herbs do not help get rid of the tumor and stop the symptoms of BPH. Non-traditional methods of therapy can be used only for auxiliary purposes and only after agreement with the attending physician.

Also completely inefficient are:

• Prayers.
• Conspiracies.
• Peroxide and herbal enemas.

Prayers and conspiracies are nothing more than self-hypnosis. You should not rely on these non-drug methods of treatment. There are no miracle cures. Prostate adenoma is an extremely dangerous disease that should be treated conservatively or promptly.

Also, do not practice treatment with peroxide or enemas. Such methods are not only ineffective, but also dangerous. With the introduction of peroxide or herbs rectally, the mucous membrane of the rectum and the prostate can be damaged.

Prostate adenoma treatment

Recently, the treatment of prostate adenoma has been rapidly developing. If 5 years ago there was practically no real alternative to surgical treatment of prostate adenoma (prostate gland), today the widest choice of various methods for treating this disease is offered.

Prostate adenoma treatment is an impressive list, and can be represented by the following classification.

• Drug treatment of prostate adenoma (prostate gland).
• Surgical treatment of prostate adenoma (prostate gland). Open adenomectomy.
• TUR of the prostate. Transurethral electroincision of the prostate.
• Transurethral electrovaporization of the prostate
• Methods of transurethral endoscopic laser prostate surgery (vaporization, ablation, coagulation, incision).

• Endoscopic thermal methods of prostate adenoma (prostate gland). Interstitial laser coagulation.
• Transurethral needle ablation

• Transrectal microwave hyperthermia.
• Transurethral microwave (radio frequency) thermotherapy.
• Transurethral radiofrequency thermal destruction.
• Transrectal focused ultrasound thermal ablation
• Extracorporeal pyrotherapy.

The presence of a significant number of methods used to treat one disease indicates that none of them is ideal and requires determining its place in the structure of the treatment of prostate adenoma. At the same time, the method of treating prostate adenoma in a particular clinical case is determined by the balance of efficiency and safety factors, which together ensure the maintenance of the necessary quality of life for the patient.

Clinical experience allows us to identify both individual and group criteria for selecting patients with BPH for treatment with a specific method:

• nature (irritative/obstructive) and severity of symptoms (IPSS/QOL);
• the presence of complications of prostate adenoma;
• the nature and degree of urodynamic disorders according to UFM, determination of the amount of residual urine and complex UDI (cystomanometry, "pressure-flow");
• dimensions, echostructure and spatial geometry of the prostate;
• the presence of a concomitant (including recurrent) infection of the urinary tract, primarily chronic prostatitis;
• condition and degree of disorders of the upper urinary tract and bladder;
• General somatic status of the patient, presence and severity of concomitant diseases

When choosing a method of treatment for a particular patient, it is necessary to evaluate a number of parameters. First of all, find out which manifestations of the disease dominate in the clinical picture of prostate adenoma: irritative symptoms or obstructive ones, the dynamic or mechanical components of the obstruction predominate, and what is the degree of urodynamic disorders. The answer to these questions will allow predicting the development of the disease with a high degree of certainty and choosing the method of treatment necessary for this patient.

The next step in choosing a treatment method is to determine the degree of effectiveness of treatment with a sufficient level of safety required by this patient. It is far from always necessary to strive to achieve maximum urinary flow rates in elderly patients if it is possible to provide satisfactory urination parameters with less means while maintaining an acceptable quality of life. At an early stage of the disease, drug therapy and minimally invasive methods may well provide the necessary level of effectiveness with minimal risk of complications. Alternative methods can be used both in patients with moderate manifestations of prostate adenoma, and in somatically burdened patients, where it is unsafe to use surgical treatments.

Drug treatment of prostate adenoma

Drugs occupy an important place in the structure of the treatment of prostate adenoma. The principles of their application are based on modern ideas about the pathogenesis of the disease. The main directions of drug therapy used to treat prostate adenoma can be represented by the following classification.

• Alpha-blockers. Non-selective.
• Selective.

• Synthetic.
• Vegetable.

Alpha-adrenergic blockers

In recent years, much attention has been paid to alpha-adrenergic receptor blockers, the use of which is considered as a promising direction in the drug treatment of prostate adenoma. The basis for the use of alpha-blockers in prostate adenoma was the accumulated data on the role of sympathetic regulation disorders in the pathogenesis of the disease.Studies have found that alpha-adrenergic receptors are localized mainly in the neck of the bladder, prostatic urethra, capsule and stroma of the prostate. Stimulation of alpha-adrenergic receptors, resulting from the growth and progression of prostate adenoma, leads to an increase in the tone of the smooth muscle structures of the base of the bladder, the back of the urethra and the prostate. This mechanism, according to most researchers, is responsible for the development of the dynamic component of obstruction in prostate adenoma.

The effect of alpha-blockers depends on the selectivity of action on various receptor subtypes. Studies of prostate adrenergic receptors have established the predominant role of alpha-adrenergic receptors in the pathogenesis of prostate adenoma.

Further identification of alpha-adrenergic receptors localized in various tissues using pharmacological and molecular biological methods revealed three subtypes of receptors. According to the new nomenclature adopted by the International Pharmacological Union in pharmacological research, they are referred to as alpha-A, alpha-B and alpha-D. A series of studies have established that the alpha-A subtype, previously cloned as alpha-C, is present in the greatest amount in the human prostate and accounts for up to 70% of all e-alpha-adrenergic receptors. This subtype is mainly responsible for the contraction of the smooth muscle elements of the prostate and has the greatest impact on the development of dynamic obstruction in prostate adenoma.

The appointment of alpha-blockers leads to a decrease in the tone of the smooth muscle structures of the bladder neck and prostate, which leads to a decrease in urethral resistance and, as a result, infravesical obstruction. Although it is currently unknown which of the receptor subtypes is responsible for the regulation of blood pressure and the occurrence of adverse reactions when using alpha-blockers. suggest that it is the alpha-B subtype that is involved in the contraction of the smooth muscle elements of the walls of the main human arteries.

Since the first publication of materials on the effectiveness of alpha-blockers in the treatment of prostate adenoma in 1976, more than 20 studies of various drugs with a similar effect have been conducted in the world. The study of the results of the use of alpha-blockers in patients with prostate adenoma began with non-selective drugs such as phentolamine. It has been established that long-term use of these drugs in stage I prostate adenoma allows achieving an effect in 70% of cases. However, today the use of non-selective alpha-blockers is limited due to the frequent occurrence of adverse reactions from the cardiovascular system, observed in 30% of patients.

Currently, selective alpha-blockers are successfully used in clinical practice. such as prazosin, alfuzosin, doxazosin and terazosin, as well as the superselective alpha1-blocker tamsulosin. It should be noted that all of them (except tamsulosin) have a comparable clinical effect with almost the same number of adverse reactions.

Data from controlled studies indicate that against the background of the use of alpha-blockers, the reduction in symptoms is about 50-60%. reaching in some cases 60-75%. Selective alpha-blockers affect both obstructive and irritative symptoms of the disease. Studies with doxazosin and alfuzosin showed a reduction in obstructive symptoms of 43% and 40% with a regression of irritative symptoms of 35% and 29%, respectively. Alpha-blockers are especially effective in patients with severe daytime and nocturnal pollakiuria. imperative urge to urinate with mild or moderate symptoms of dynamic obstruction.

Against the background of treatment with alpha-blockers, an improvement in urodynamic parameters is observed: an increase in Qmax by an average of 1.5-3.5 ml / s or 30-47%. a decrease in maximum detrusor pressure and opening pressure, as well as a decrease in the amount of residual urine by about 50%. The dynamics of these urodynamic parameters indicates an objective decrease in infravesical obstruction in the treatment of alpha-blockers. No significant changes in prostate volume have been registered during treatment with these drugs.

A series of studies with prazosin, alfuzosin, doxazosin, terazosin and tamsulosin has proven the safety and efficacy of alpha-blockers with long-term (more than 6 months) use. Currently, there are observations of priming alpha-blockers for up to 5 years. At the same time, a pronounced symptomatic improvement and dynamics of objective indicators are usually observed in the first 2-4 weeks of use and persist during the subsequent period of treatment. If a positive effect cannot be achieved after 3-4 months.then the further use of these drugs is futile, it is necessary to decide on the choice of another type of treatment for adenoma.

It is important that alpha-blockers do not affect the metabolism and concentration of hormones and do not change the level of PSA. These drugs (doxazosin) can have a positive effect on the blood lipid profile, reducing the level of lipoproteins, cholesterol and triglycerides. In addition, alpha-blockers have a positive effect on the body's tolerance to glucose, increasing its sensitivity to insulin.

According to statistics, adverse reactions against the background of the use of alpha-blockers are recorded in 10-16% of patients in the form of malaise, weakness, dizziness, headache, orthostatic hypotension (2-5%), tachycardia or tachyarrhythmia. In a number of observations (4%), cases of retrograde ejaculation were noted. At the same time, 5-8% of patients refuse further treatment with alpha-blockers due to the development of adverse reactions. Thus, dizziness was observed in 9.1-11.7% of patients treated with terazozyme, in 19-24% while taking doxazosin and in 6.5% of those treated with alfuzosin. Headache was noted by 12-14% of patients while taking terazosin and 1.6% of alfuzosin. A decrease in blood pressure was registered in 1.3-3.9% of patients during therapy with terazosin. and in 8% and 0.8% of patients taking doxazosin and alfuzosin, respectively. Palpitations and tachycardia occurred in 0.9% and 2.4% of patients during treatment with terazosin and alfuzosin, respectively. It should be borne in mind that the frequency of occurrence of undesirable effects depends on the dose of the drug used and the duration of its administration. With an increase in the duration of treatment, the number of patients reporting the presence of adverse reactions decreases, and therefore, to reduce their number, treatment with prazosin. alfuzosin. doxazosin and terazosin should be started at the lowest starting dose and then moved up to the therapeutic dose. For prazosin it is 4-5 mg/day (in 2 doses), for alfuzosin 5-7.5 mg/day (in 2 doses), for doxazosin 2-8 mg/day (once), for terazosin 5-10 mg /day (once).

Clinical data on the use of tamsulosin indicate a high, comparable with other alpha-blockers, the effectiveness of the drug with a minimum number of adverse reactions. When treated with tamsulosin, side effects are observed in 2.9% of patients. At the same time, no effect of the drug on the dynamics of blood pressure was noted, and the incidence of other adverse reactions did not significantly differ from that in patients in the placebo group. Given the high efficiency and rapid onset of the clinical effect, alpha-blockers are currently considered as first-line drug therapy.

Treatment of prostate (prostate) adenoma: 5-a-reductase inhibitors

The most common treatments for BPH include 5-a-reductase inhibitors (finasteride, dutasteride). Currently, the greatest experimental and clinical experience is associated with the use of finasteride. Finasteride. related to 4-azasteroids, a powerful competitive inhibitor of the enzyme 5-a-reductase. predominantly type II, blocks the conversion of testosterone to dihydrotestosterone at the prostate level. The drug does not bind to androgen receptors and does not have side effects characteristic of hormonal drugs.

Toxicological studies in humans have shown finasteride to be well tolerated. In healthy male volunteers, the drug was first used in 1986. Currently, there is an experience of using it for 5 years or more without any significant adverse reactions.

As a result of research, the optimal dose of finasteride was determined: 5 mg / day. In patients receiving finasteride at a dose of 5 mg / day. after 6 months, a decrease in the level of dihydrotestosterone by 70-80% is noted. At the same time, the decrease in the size of the prostate after 3 months was 18%. reaching 27% after 6 months. Qmax after 6 months increased by 3.7 ml/s. In addition, after 3 months of taking finasteride, a decrease in PSA by about 50% is noted. In the future, the PSA concentration remains at a low level, correlating with the activity of prostate cells. A decrease in PSA levels during finasteride therapy may make it difficult to timely diagnose prostate cancer. When evaluating the results of a study of PSA levels in patients taking finasteride for a long time, it should be borne in mind that PSA levels in this group are 2 times lower compared to the corresponding age norm.

Studies have shown that the use of finasteride leads to a significant reduction in the risk of developing acute urinary retention by 57% and a decrease in the likelihood of surgical treatment of prostate adenoma by 34%. The use of finasteride reduces the risk of prostate cancer by 25%.

Combined treatment of prostate adenoma (prostate gland)

In 1992, the first reports appeared on the advisability of using alpha-blockers in combination with 5-a-reductase inhibitors in patients with BPH to provide a rapid improvement in urination followed by a decrease in prostate volume. However, despite the fact that this approach is pathogenetically justified, studies conducted to date do not provide sufficient evidence to confirm the clinical benefits of combination therapy with alpha-blockers (terazosin) and finasteride compared with monotherapy with alpha-blockers.

The different and complementary mechanisms of action of 5α-reductase inhibitors and alpha-blockers provide a powerful rationale for combination therapy.

Data from the large-scale MTOPS trials, which tested the combination of finasteride and doxazosin, and the COMBAT, which evaluated the combination of dutasteride and tamsulosin, suggest a significant benefit of combination therapy compared to either drug alone in terms of improvement in symptoms, voiding rate, patient quality of life, and also slowing the progression of the disease.

The modern 5-a-reductase inhibitor dutasteride (Avodart) inhibits the activity of type I and II 5-a-reductase isoenzymes, which are responsible for the conversion of testosterone to dihydrotestoaerone, which is the main androgen responsible for the development of benign prostatic hyperplasia.

After 1 and 2 weeks of taking dutasteride at a dose of 0.5 mg per day, the median values of serum dihydrotestosterone concentrations are reduced by 85 and 90%.

Data from 4-year, large-scale, multicenter, randomized clinical trials demonstrate the efficacy and safety of Avodart.

Dutasteride provides a sustained reduction in symptoms and slows the progression of the disease in patients with a prostate volume of more than 30 ml. Qmax and prostate volume change already during the first month of therapy, which is probably due to the inhibition of both types of 5-a-reductase, in contrast to the first drug from this group, finasteride, which blocks only type II 5-a-reductase.

Long-term treatment of BPH with Avodart resulted in continued improvement in total AUA-SI score (-6.5 points) and Qmax (2.7 ml/s).

Avodart leads to a significant reduction in both total prostate volume and the prostate transition zone (by 27%) in men with benign prostatic hyperplasia compared with placebo.

Studies have also shown a 57% reduction in the risk of acute urinary retention and a 48% reduction in the need for surgery with Avodart compared with placebo.

The 2-year period of the international COMBAT study has now been completed, showing for the first time a significant benefit in improving symptoms with combination therapy compared with monotherapy with each drug during the first 12 months of treatment.

The occurrence of adverse events associated with the drug in patients receiving dutasteride is more common at the beginning of treatment for BPH and decreases over time.

There may be impotence, decreased libido, impaired ejaculation, gynecomastia (includes soreness and enlargement of the mammary glands). Very rare: allergic reactions.