The effects of 5-ARIs on prostate volume in patients with or without heart failure and benign prostate hyperplasia: prospective, comparative study

Abstract

Objective: Compare the effects of finasteride and dutasteride on prostate volume in men with or without chronic heart failure (CHF) and benign prostate hyperplasia (BPH).

Materials and methods: Five hundred and seventy-nine patients were recruited with symptomatic BPH receiving inhibitors of 5-alpha reductase from December 2022 to January 2024. Five hundred and forty-six patients were followed up during 12 months. The study included analysis of four groups of patients: Group I (n = 136) received dutasteride and had chronic cardiac failure; Group II (n = 137) received finasteride and had chronic cardiac failure; Group III (n = 136) received dutasteride and had no chronic cardiac failure; Group IV (n = 137) received finasteride and had no chronic cardiac failure. Prostate volume, PSA level, total IPSS and its voiding and storage subscores, Q_max, post-voided residual urine volume (PVR) were evaluated at baseline and after 6 and 12 months. Echocardiography, electrocardiography and brain natriuretic peptide (BNP) testing were performed for diagnosis of chronic cardiac failure in all patients.  Statistical significance was set at P < 0.05.

Results:  The IPSS (total, storage, and voiding symptom) score was significantly decreased after 6 and 12 months of treatment in group III and IV (P < 0.01). The reducing of prostate volume was effective in groups III and IV in patients without chronic cardiac failure. There were not statistically significant differences in reducing of prostate volume at 6 and 12 months of treatment in all groups (P > 0.05). However, the patients with chronic heart failure had a worse effect of inhibitors 5-alpha reductase on prostate volume. The patients with BNP >100 pg/mL and left ventricular ejection fraction (LVEF) ≤ 40% had the most minimal reducing of prostate volume at 6- and 12-month treatment. In groups III and IV, the postvoid residual urine volume (PVR) and Q_max were significantly decreased (P < 0.05) at 6 and 12 months of treatment compared with the baseline values. The patients with CHF did not receive any benefits in regarding to PVR, Q_max and IPSS score during 12 months of treatment.

Conclusion: Dutasteride and finasteride had no effect on prostate volume in patients with CHF, BNP > 100 pg/mL and with severely abnormal (< 30%) and moderately abnormal (≥ 30% ≤ 40%) LVEF. The patients with BPH and CHF did not receive any benefits in regarding to PVR, Q_max and IPSS score improvement after treatment with dutasteride or finasteride.

Keywords: Benign prostate hyperplasia; chronic heart failure; left ventricular ejection fraction; lower urinary tract symptoms; 5-alpha reductase inhibitors