NEW YORK (Reuters) -- Confusion over which of two drugs doctors should prescribe for benign prostatic enlargement may be lessened by the results of a new study.
A report in this week's issue of The New England Journal of Medicine says that terazosin, a drug that relaxes smooth muscle in the prostate, works better than a prostate shrinking drug, finasteride, to clear up troublesome symptoms.
The study by Veterans Affairs (VA) medical researchers from around the country is the first to compare the two agents, both of which they describe as alternatives to surgery for men whose enlarged prostates interfere with urination.
"In men with benign prostatic hyperplasia, terazosin was effective therapy, whereas finasteride was not, and the combination of terazosin and finasteride was no more effective than terazosin alone," state Dr. Herbert Lepor of New York University's VA Medical Center and his colleagues.
According to urologist Dr. Patrick C. Walsh of Johns Hopkins Hospital in Baltimore, results of this VA study of more than 1,200 men with enlarged prostates conflict with earlier studies that found finasteride effective in men with this disorder.
But rather than cause for confusion, Walsh sees the new VA findings as pointing to a distinction between two types of prostate overgrowth. He notes that either drug would do the job if used for the right kind of problem.
"Benign prostatic hyperplasia was once thought to be a disorder in which the prostate gland was enlarged and caused symptoms. There is, however, another condition in which men with small prostate glands have the same symptoms."
He says the earlier studies of finasteride recruited men with "true" benign prostate enlargement, "those in whom a reduction in prostate size would be expected to improve symptoms." Thus, he says, the prostate-shrinking drug proved superior.
On the other hand, Walsh points out that the new VA study involved men with symptoms of the lower urinary tract, but not necessarily prostatic hyperplasia, a condition which is less well understood scientifically, he notes.
As to which drug to use, the determining factor, according to the Baltimore doctor, is whether or not a digital rectal exam indicates prostate enlargement in men with symptoms.
Walsh says if the prostate is enlarged "as it is in nearly a quarter of men 60 to 69 years of age," then treatment with either drug "is a reasonable option." But if a man with symptoms does not have an enlarged prostate, he should be treated with the muscle-relaxing terazosin or drugs similar to it.
"If symptoms are minimal, no therapy is necessary, no matter what the size of the prostate, and if they are severe, surgery may be the best approach," Walsh concludes.
Source: The New England Journal of Medicine (1996;335:533-539)
