Pathogenetic justification of 5-alpha reductase inhibitors use in benign prostatic hyperplasia treatment

Introduction. Benign prostatic hyperplasia (BPH) is one of the commonest urological diseases. Aim. To review current research on the use of 5-alfa-reductase inhibinors (5-ARI) in the treatment of BPH: finasteride and dutasteride. Materials and methods. We have done a search and analysis of publications for last 20 years using elibrary, PubMed, Cochrane Collaboration and Embase databases. The inclusion criteria were: prospective (cohort) studies and randomized clinical trials (RCTs). The total number of sources included in this review was 36. Results and discussion. The review highlights the following sections: clinical and side effects of 5-ARI inhibitors, evaluation of the effectiveness of therapy with 5-ARI inhibitors and the reasons for its inefficiency, conclusions. The analysis of works devoted to the clinical effects of 5-ARI showed the absence of a complete cure for BPH against the background of modern pharmacotherapy with a moderate positive effect in most patients. The known side effects of 5-ARI suggest there are additional mechanisms of those medications besides of inhibiting the enzyme 5-alpha-reductase and new studies are needed to identify them. The lack of generally accepted indicators for 5-ARI effectiveness monitoring makes it difficult to assess it. And the insufficient effectiveness of drug treatment of BPH may be associated with the inability to classify the pathophysiological diversity of the disease and its phenotypes. Conclusions. New studies are needed to study the individual specific composition of the pancreatic tissue and a deeper understanding of the pathogenesis of the disease, which will improve the results of drug therapy and develop individual therapeutic solutions for patients.