Continued use of Finasteride

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alsace
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Joined: Mon Nov 19, 2012 8:35 pm
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by alsace on Mon Nov 19, 2012 9:05 pm

Continued use of Finasteride

I am 63 years old and suffered from symptoms of BPH since about 2005. Due to raised PSA I underwent a biopsy in Mid 2010. No cancer detected and so went off to the States to celebrate!
On the plane-2hours into the flight I went into Urinary Retention. In the states I was catheterised and amongst other things put on Finasteride. Back in the UK I underwent Cystoscopy where as well as the large prostate 2 large stones were found. It was recommended that I undergo TURP and I eventually agreed to this as the stones were causing blood in the urine. The operation was done in Dec 2011. The Consultant shaved (his words) the middle lobe only as well as removing the stones. At follow up he reaffirmed that I should continue with the Finasteride as he was of the view that Prostates do not stop growing and therefore the use of Finasteride would significantly reduce the likelihood of a further TURP in the future.

Before I get to my query if there is anyone reading this wondering about the benefits of TURP then for me at least it as been genuinely life changing. From an IPSS of 18-23 it is now consistently at 1. From urinating every 45 minutes in the day to now every 2-3 hours is so incredibly liberating
. Incidently I have never sufferred fron Nocturia.
So my query. I do not like taking drugs unless I really have too. Information on the Internet is equivocal. I really would like to give up the Finasteride but I do not want to undergoe further prostate surgery. Is there an age beyond which my prostate will either stop growing or grow so slowly that I can stop taking this? Also if I do continue is there any way of calculating the liklihood of further surgery given that only the middle lobe has been reduced.

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Dr Jon Rees
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Joined: Mon Nov 21, 2011 3:07 pm
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by Dr Jon Rees on Mon Nov 19, 2012 10:22 pm

Re: Continued use of Finasteride

Hi

Great question and I hope I have an answer for you.

Finasteride and data sterile are 5-alpha reductive inhibitors or 5ARI's. They do 2 main things. Firstly they are used to improve symptoms, either on their own or often in combination with a drug like tamsulosin (alpha blocker). Secondly, they are sometimes used to decrease the risk of so called progression, ie worsening symptoms, urinary retention and surgery such as TURP.

Most of the evidence I am aware of is in men who have not had TURP. Recently a trial reported results for using 5aris to prevent symptoms in men without symptoms of significance, and I would say the results were far from impressive. So, in a man who has had a successful TURP, to me using a 5ari to prevent future symptoms is not necessary as the treatment can easily be started if you begin to notice worsening symptoms. In terms of preventing retention etc, the evidence suggests that the men who are most at risk of this are those with severe symptoms, older age ie at least over 70, big prostates on examination, PSA>1.4 and slow flow rates. However, this is for men with symptoms who have not had TURP. You have well controlled symptoms and a recent TURP.

If it was me, I would stop the finasteride and see what happened. You can easily restart medication if you notice a deterioration. I would be interested to see the views of the other health professionals on this forum.
Dr Jon Rees
GP, Backwell & Nailsea Medical Group with specialist interest in Men’s Health and Urology

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Philippa Aslet
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by Philippa Aslet on Wed Nov 21, 2012 8:50 am

Re: Continued use of Finasteride

I would agree with Dr Rees.
It is good to hear that you have had successful surgery. The surgery has cleared the prostate tissue pressing on the waterpipe which was causing the blockage and the bothersome urinary symptoms. So it would seem entirely reasonable and safe to stop the medication. As Dr Rees says if you get a recurrance of sympoms then medication can be re started.
Philippa Aslet
Senior Urology Specialist Nurse

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