Following the old adage ‘prevention is better than cure’, this Canadian group performed a post hoc analysis of information gained from the multicentre Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study to evaluate whether dutasteride could decrease the incidence of clinical progression of asymptomatic or minimally symptomatic benign prostatic hyperplasia (BPH). All men in the study with a prostate size 40-80mls and baseline International Prostate Symptom Score (IPSS) <8 points were included. Exclusion criteria included those taking medication for BPH at study entry. The risk of clinical progression of BPH at four years, defined as worsening IPSS score ≥4 points, BPH related acute retention or surgery, or urinary tract infection, was compared between those taking dutasteride (792 men) and those taking a placebo (825 men). Overall, 21% of those taking dutasteride experienced progression, compared with 36% of those taking a placebo, giving a relative risk reduction of 41% and an absolute risk reduction of 15% (NNT=6.7). There was a significant reduction of clinical progression in the dutasteride group on multivariable regression analysis adjusting for covariates. Despite these overall positive findings, the rate of adverse events, namely sexual dysfunction, and the cost-effectiveness of treating asymptomatic patients needs to be considered. The risks need to be weighed up for each individual before initiating treatment.
The role of dutasteride in the prevention of clinical progression in asymptomatic BPH
Reviewed by Sophia Cashman
Effect of dutasteride on clinical progression of benign prostatic hyperplasia in asymptomatic men with enlarged prostate: a post hoc analysis of the REDUCE study.
