From the Guidelines
Dutasteride is the preferred treatment option for Benign Prostatic Hyperplasia (BPH) due to its slightly better efficacy compared to finasteride, as evidenced by the most recent study 1.
Comparison of Finasteride and Dutasteride
Both finasteride and dutasteride are effective medications for treating BPH, with dutasteride inhibiting both type 1 and type 2 5-alpha reductase enzymes, leading to a more complete suppression of dihydrotestosterone (DHT) 1.
- Finasteride (5mg daily) inhibits only type 2 5-alpha reductase enzyme, reducing DHT levels by approximately 70% 1.
- Dutasteride (0.5mg daily) inhibits both type 1 and type 2 enzymes, reducing DHT levels by about 95% 1.
Efficacy and Side Effects
- Dutasteride provides modestly greater improvements in urinary symptoms, flow rate, and prostate volume reduction compared to finasteride 1.
- Both medications take 3-6 months to show full benefits and have similar side effect profiles, including sexual dysfunction (decreased libido, erectile dysfunction), ejaculatory disorders, and rare cases of gynecomastia 1.
- Both can also lower PSA levels by approximately 50%, which physicians must account for when screening for prostate cancer 1.
Treatment Considerations
- The choice between finasteride and dutasteride should be individualized based on symptom severity, cost considerations, and patient preference, with either medication representing a reasonable option for long-term BPH management 1.
- Cost may be a deciding factor, as finasteride is available as a generic and typically less expensive 1.
- Dutasteride is recommended for patients with larger prostates or higher PSA values, as it has been shown to reduce the risk of clinical progression and improve symptoms in these patients 1.
From the Research
Comparison of Finasteride and Dutasteride
- Finasteride and dutasteride are both used to treat Benign Prostatic Hyperplasia (BPH) by inhibiting 5alpha-reductase activity, which reduces dihydrotestosterone levels 2, 3.
- Finasteride inhibits type 2 5alpha-reductase, while dutasteride inhibits both type 1 and type 2 5alpha-reductase, resulting in near-complete suppression of serum dihydrotestosterone 3.
- Studies have shown that finasteride reduces prostate volume, improves urinary flow rates, and alleviates symptoms in patients with BPH 2, 4.
- Dutasteride has also been shown to reduce prostate volume, improve urinary flow rates, and alleviate symptoms in patients with BPH, with some studies suggesting it may be more effective than finasteride in improving maximum urinary flow rate (Qmax) 3, 5.
Efficacy and Safety
- A systematic review and meta-analysis found that dutasteride was more effective than finasteride in improving Qmax, but there was no significant difference in reducing International Prostate Symptom Score (IPSS), improving prostate volume, quality of life, or serum prostate-specific antigen level, or in the occurrence of adverse drug reactions 5.
- Finasteride has been shown to reduce the risk of BPH-related acute urinary retention and the need for surgical intervention 2, 4.
- Both finasteride and dutasteride have been associated with sexual side effects, such as erectile dysfunction, decreased libido, and ejaculation disorders, although the incidence of these side effects may be lower with finasteride 2, 3, 6.
Clinical Use
- Finasteride is generally well-tolerated and is considered a first-line treatment option for patients with moderate uncomplicated BPH, especially those with a large prostate (> 40 ml) 2, 6.
- Dutasteride is also an effective and safe treatment for BPH, and may be considered for patients who do not respond to finasteride or who have a contraindication to finasteride 3, 5.
- The choice between finasteride and dutasteride should be based on individual patient factors, such as prostate size, symptom severity, and medical history, as well as the potential for side effects and interactions with other medications 2, 3, 6.