Focus on Finasteride: Efficacy, Mechanisms, and Recommendations for Clinical Use

Finasteride is a key treatment for benign prostatic hyperplasia (BPH) in older men, effectively reducing prostate volume, improving urinary flow, and decreasing the risk of acute urinary retention and surgery by lowering intraprostatic dihydrotestosterone levels. Studies like PLESS and MTOPS support its long-term efficacy and safety. It also reduces perioperative bleeding in transurethral resection of the prostate (TURP) and treats BPH-related hematuria due to its antiangiogenic and antiproliferative effects. While its role in prostate cancer chemoprevention is debated, meta-analyses suggest it lowers low-grade tumor incidence without increasing high-grade forms. Finasteride offers therapeutic benefits over α-blockers for certain patients, and combination therapy enhances symptom control and reduces progression risk. Its favorable safety profile and clinical versatility make finasteride a reference treatment for personalized BPH management.