alpha-Blocker Monotherapy and alpha-Blocker Plus 5-Alpha-Reductase Inhibitor Combination Treatment in Benign Prostatic Hyperplasia; 10 Years' Long-Term Results

Purpose: We compared the effects of alpha-adrenergic receptor blocker (a-blocker) monotherapy with those of combination therapy with a-blocker and 5-alpha-reductase inhibitor (5-ARI) on benign prostatic hyperplasia (BPH) progression for over 10 years. Materials and Methods: A total of 620 patients with BPH who received a-blocker monotherapy (a-blocker group, n=368) or combination therapy (combination group, n=252) as their initial treatment were enrolled from January 1989 to June 2000. The incidences of acute urinary retention (AUR) and BPH-related surgery were compared between the two groups. Incidences stratified by follow-up period, prostate-specific antigen (PSA), and prostate volume (PV) were compared between the two groups. Results: The incidence of AUR was 13.6% (50/368) in the a-blocker group and 2.8% (7/252) in the combination group (p<0.001). A total of 8.4% (31/368) and 3.2% (8/252) of patients underwent BPH-related surgery in the a-blocker and combination groups, respectively (p=0.008). According to the follow-up period, the incidence of AUR was significantly decreased in combination group. However, the incidence of BPH-related surgery was significantly reduced after 7 years of combination therapy. Cutoff levels of PSA and PV for reducing the incidences of AUR and BPH-related surgery were 2.0 ng/ml and 35 g, respectively (p<0.001). Conclusions: Long-term combination therapy with a-blocker and 5-ARI can suppress the progression of BPH more efficiently than a-blocker monotherapy. For patients with BPH with PSA > 2.0 ng/ml or PV > 35 ml, combination therapy promises a better effect for reducing the risk of BPH progression.