Discontinuation of Alpha-Blockade after Initial Treatment with Finasteride and Doxazosin for Bladder Outlet Obstruction

Abstract

Objectives: Patients with symptomatic bladder outlet obstruction and moderately enlarged prostates can receive durable relief from finasteride. However, the delayed onset of action has led many clinicians to prescribe an α-blocker in addition to finasteride early in therapy for more rapid symptom relief. Our goal was to determine when to discontinue the α-blocker in this group of patients. Methods: We enrolled 100 consecutive men with an estimated prostate size of >40 g and an AUA symptom score of ≧20, who reported an initially favorable response to combination therapy with 5 mg finasteride and 2 mg doxazosin daily. The average symptom score reduction at 1 month was 3.3. We discontinued the doxazosin at 3, 6, 9, or 12 months, while continuing finasteride, then reevaluated patients 1 month later to determine if the patients reported any worsening of symptoms. Results: Twenty-five patients discontinued doxazosin at 3 months. Five (20%) were successfully discontinued, reporting no change in symptom score. Twenty reported worsening symptoms. Twenty-five patients discontinued doxazosin at 6 months. Twelve (48%) were successfully discontinued, reporting no change in symptom scores. Thirteen (52%) reported worsening symptoms. Twenty-five patients discontinued doxazosin at 9 months. Twenty-one (84%) were successfully discontinued, reporting no change in symptom scores. Four (16%) reported worsening symptoms. Twenty-five patients discontinued doxazosin at 12 months. Twenty-one (84%) were successfully discontinued, reporting no change in symptom scores. Four (16%) reported worsening symptoms. Conclusion: Patients with symptomatic bladder outlet obstruction and moderately enlarged prostates who are placed initially on combination therapy using finasteride and an α-blocker are likely to tolerate discontinuation of the α-blocker after 9 months of combination therapy.