Finasteride Reduces the Risk of Incident Clinical Benign Prostatic Hyperplasia

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• 作者：J. Kellogg Parsons ; Jeannette M. Schenk ; Kathryn B. Arnold ; Karen Messer ; Cathee Till ; Ian M. Thompson ; Alan R. Kristal ; ; the Urologic Diseases in America Project for the Prostate Cancer Prevention Trial
• 关键词：Prostatic hyperplasia ; Finasteride ; 5¦Á-reductase inhibitor ; Prevention and control ; Prostatic neoplasm
• 刊名：European Urology
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：62
• 期：2
• 页码：234-241
• 全文大小：401 K

文摘

Background

Despite the high prevalence of clinical benign prostatic hyperplasia (BPH) among older men, there remains a notable absence of studies focused on BPH prevention.

Objective

To determine if finasteride prevents incident clinical BPH in healthy older men.

Design, setting, and participants

Data for this study are from the Prostate Cancer Prevention Trial. After excluding those with a history of BPH diagnosis or treatment, or an International Prostate Symptom Score (IPSS) ¡Ý8 at study entry, 9253 men were available for analysis.

Outcome measurements and statistical analysis

The primary outcome was incident clinical BPH, defined as the initiation of medical treatment, surgery, or sustained, clinically significant urinary symptoms (IPSS >14). Finasteride efficacy was estimated using Cox proportional regression models to generate hazards ratios (HRs).

Results and limitations

Mean length of follow-up was 5.3 yr. The rate of clinical BPH was 19 per 1000 person-years in the placebo arm and 11 per 1000 person-years in the finasteride arm (p < 0.001). In a covariate-adjusted model, finasteride reduced the risk of incident clinical BPH by 40 % (HR: 0.60; 95 % confidence interval, 0.51-0.69; p < 0.001). The effect of finasteride on incident clinical BPH was attenuated in men with a body mass index ¡Ý30 kg/m² (p_interaction = 0.04) but otherwise did not differ significantly by physical activity, age, race, current diabetes, or current smoking. The post hoc nature of the analysis is a potential study limitation.

Conclusions

Finasteride substantially reduces the risk of incident clinical BPH in healthy older men. These results should be considered in formulating recommendations for the use of finasteride to prevent prostate diseases in asymptomatic older men.