Survey of the Literature for March 2015 Issue of Sexual Medicine Journal

Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. A Casabé, CG Roehrborn, LF Da Pozzo, S Zepeda, RJ Henderson, S Sorsaburu, C Henneges, DG Wong, L Viktrup. J Urol 2014;191:727–33. Editorial Comment: Since the launch of the 5-alpha reductase inhibitor finasteride in 1992, medical management of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH) has continued to evolve. Today, in addition to 5-alpha reductase inhibitors, both alpha-blockers and phosphodiesterase type-5 inhibitors are approved for the treatment of men with BPH/LUTS. Recently, various guidelines have recommended combination of a 5-alpha reductase inhibitor with an alpha-blocker to achieve earlier and greater LUTS improvement when compared with monotherapy of either group of drug alone. However, there is an increased risk of sexual dysfunction related to this combination of therapies that constructs the major concern related to this treatment option. Tadalafil is a long-acting phosphodiesterase type-5 inhibitor that has recently been approved for the treatment BPH/LUTS. Clinical studies have demonstrated that tadalafil 5 mg once daily results in clinically significant improvements in BPH/ LUTSwith the additional benefit of restoring erectile function in patients with concomitant erectile dysfunction. In order to assess whether the combination of a 5-alpha reductase inhibitorwith tadalafil may result in early LUTS improvement with fewer sexual side effects, Casabé et al. conducted a randomized, double-blind, placebo-controlled, multicenter study. The authors randomized 695 men to receive either tadalafil 5 mg or placebo once daily co-administered with finasteride 5 mg once daily over the course of 26 weeks. The results of this study demonstrated that tadalafil 5 mg coadministered with finasteride resulted in more rapid and more significant LUTS improvement when compared with finasteride coadministered with placebo. Moreover, the finasteride/tadalafil combination significantly improved erectile function in men who had erectile dysfunction prior to initiation of treatment. These results support that once daily coadministration of tadalafil with finasteride can be the treatment of choice for men with LUTS and erectile dysfunction symptoms. Ege Can Serefoglu, MD, FECSM