NEW YORK (Reuters Health) - Long-term use of the drug Proscar cuts the need for surgery in men with enlarged prostates, according to a new analysis that pooled the best available research on the medication.
About four in 10 men in their fifties have enlarged prostate glands, a non-cancerous condition that may cause urgency, leaking and other urinary problems, because the gland presses on the urethra.
Not all men are equally troubled by the growing gland, and common advice includes lifestyle changes such as cutting down on alcohol and coffee.
When that doesn't work, several drugs and surgical treatments are available, but all of them have side effects.
Proscar, also called finasteride, is a common drug that reduces the size of the prostate. The new analysis is based on data from more than 21,000 men studied in 23 clinical trials, most of which were funded by companies that make drugs to treat the condition.
Most studies found Proscar did little to relieve urinary symptoms, although it worked better for men with the largest prostates.
One study showed that it prevented symptoms from worsening in about five percent of men. And several studies showed treatment longer than one year cut the chances -- by three percent -- that men needed surgery or would land in the emergency room because they couldn't urinate.
Proscar was more effective when used in combination with Cardura, a drug known generically as doxazosin that relaxes the muscles around the bladder and makes it easier to urinate.
But the combination also had more side effects. According to the new report, published by The Cochrane Collaboration, an international organization that evaluates medical research, Proscar caused few side effects -- generally in fewer than one in 10 men.
The most common decreased libido and erectile dysfunction. Cardura, on the other hand, can trigger dizziness, low blood pressure and fatigue.
Dr. Kevin T. McVary, a urologist at Northwestern University in Chicago, who was not involved in the research, said the right treatment depends on the patient.
"Given that this is not a life-threatening condition, it is OK for the patient to be intimately involved in the decision-making," he told Reuters Health.
Proscar, for instance, might be a good option for elderly men who are no longer sexually active. In general, he said, drugs like Proscar are used in men with large prostates and are mostly used for their ability to cut the risk of visits to the emergency room. Proscar costs about $100 for a month's supply.
Other patients may prefer procedures to remove excessive prostate tissue, such as transurethral resection of the prostate or laser surgery, McVary said.
SOURCE: http://link.reuters.com/qec37p, October 5, The Cochrane Library 2010.
