Should Finasteride Be Routinely Given Preoperatively for TURP?

Objective. The aim of the review was to compare the use of finasteride to placebo in patients undergoing TURP procedures. Material & Methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966–November 2011), EMBASE (1980–November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles, and abstracts from conference proceedings without language restriction for studies comparing finasteride to placebo patients needing TURPs. Results. Four randomised controlled trials were included comparing finasteride to a placebo. A meta-analysis was not conducted due to the disparity present in the results between the studies. Three of the studies found that finasteride could reduce either intra- or postoperative bleeding after TURP. One study found finasteride to significantly lower the microvessel density (MVD) and vascular endothelial growth factor (VEGF). None of the studies reported any long-term complications related to either the medication or the procedure. Conclusion. finasteride reduces bleeding either during or after TURP. 1. Introduction Bladder outflow obstruction (BOO) due to benign prostatic hyperplasia (BPH) is the commonest urological condition affecting men over 50 years of age. Medical therapy is usually the first line management of BPH. finasteride, a 5-alpha reductase inhibitor (5ARI), blocks the conversion of testosterone into the more potent dihydrotestosterone (DHT) and has been shown to reduce blood levels by 80–85% in 1-2 weeks [1–3]. By the suppression of DHT, finasteride reduces prostatic tissue growth by decreased glandular and fibromuscular tissue and has been shown to reduce the overall size of the prostate by 30% within 6–12 months [2, 4]. Furthermore, studies have found that 5ARI also suppresses the androgen controlled vascular endothelial growth factor (VEGF), leading to decreased angiogenesis and less prostatic bleeding [2, 5, 6]. Transurethral resection of the prostate (TURP) is the gold standard modality of treatment for BPH where medical therapy has failed or when there is a risk to renal function due to BOO. Though, TURP is an established procedure, significant intraoperative as well as postoperative bleeding remains a common complication leading to postoperative clot retention and blood transfusion [7–11]. In a prospective study, Hagerty et al. were first to report a reduction in blood loss during TURP in patients taking finasteride preoperatively [8]. Since then numerous randomised controlled trials (RCTs) have also emerged to report similar findings [1, 7, 10, 11].