Journal
BEST PRACTICE & RESEARCH CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 22, Issue 2, Pages 389-402Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.beem.2008.01.016
Keywords
5 alpha-reductase; 5 alpha-reductase inhibitor; androgen; Avodart; benign prostatic hyperplasia; dihydrotestosterone; dutasteride; finasteride; prostate; prostate cancer
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Androgens play an essential role in prostatic development and function, but are also involved in prostate disease pathogenesis. The primary prostatic androgen, dihydrotestosterone (DHT), is synthesized from testosterone by 5 alpha-reductase types 1 and 2. Inhibition of the 5 alpha-reductase isoenzymes therefore has potential therapeutic benefit in prostate disease. The two currently approved 5 alpha-reductase inhibitors (5ARIs), finasteride and dutasteride, have demonstrated long-term efficacy and safety in the treatment of benign prostatic hyperplasia. Finasteride, a type-2 5ARI, has also been studied for its ability to reduce the incidence of biopsy-detectable prostate cancer in the Prostate Cancer Prevention Trial. Treatment with dutasteride, a dual 5ARI, has been shown to result in a greater degree and consistency of DHT suppression compared with finasteride. Two large-scale studies of dutasteride are currently investigating the role of near-maximal DHT suppression in the settings of prostate cancer risk reduction and expectant management of localized prostate cancer.
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