Combination of tadalafil and finasteride for improving the symptoms of benign prostatic hyperplasia: Critical appraisal and patient focus

Abstract

The evidence suggests that combination therapy for benign prostatic hyperplasia (BPH)-lower urinary tract symptoms (LUTS) using an a-blocker and a 5a-reductase inhibitor has become well accepted. The combination of daily tadalafl and an a-blocker has also demonstrated beneft. This paper addresses combination therapy with daily tadalafl and fnasteride for the treatment of BPH-LUTS. Our results demonstrate that use of tadalafl and fnasteride represents a logical extension of combination therapies. We analyze a landmark study by Casabé et al that demonstrates improved voiding symptoms as assessed by International Prostate Symptom Scores with a combination of tadalafl and fnasteride compared with fnasteride and placebo. Study patients had moderate to severe LUTS and prostate volumes >30 g. The additional beneft of improved erectile function as assessed by International Index of Erectile Function-erectile function domain scores with the addition of tadalafl was a secondary beneft. We propose that the ideal patient for combination therapy with tadalafl and fnasteride has a prostate volume >30 g and desires additional beneft over monotherapy. For these men, improved erectile function without sexual side effects was a secondary beneft.