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. 2025 Feb;32(2):151-157.
doi: 10.1111/iju.15612. Epub 2024 Oct 23.

Dutasteride, a 5 alpha reductase inhibitor, could be associated with the exacerbation of inflammation in patients with benign prostatic hyperplasia

So Inamura  1 , Yusuke Fukiage  1 , Hisato Kobayashi  1 , Manami Tsutsumiuchi  1 , Masaya Seki  1 , Minekatsu Taga  1 , Masato Fukushima  1 , Motohiro Kobayashi  2 , Osamu Yokoyama  1 , Naoki Terada  1
Affiliations

Dutasteride, a 5 alpha reductase inhibitor, could be associated with the exacerbation of inflammation in patients with benign prostatic hyperplasia

So Inamura et al. Int J Urol. 2025 Feb.

Abstract

Background: α-1 blockers and dutasteride are widely used as agents to treat benign prostatic hyperplasia (BPH); the impact of these drugs on prostatic inflammation is still unclear. Herein, we investigated the impact of α-1 blockers and dutasteride treatment of BPH in terms of the degree of prostatic inflammation.

Materials and methods: Tissue specimens were obtained from 143 BPH patients who were administered α-1 blockers up until their operation. Thirty-three of the patients had also been treated with dutasteride before the procedure. The degree of prostatic inflammation was quantified histologically by the ratio of high endothelial venule (HEV)-like vessels. We divided this retrospective cohort into α-1 blocker monotherapy and combination therapy (α-1 blockers + dutasteride) groups and evaluated clinical parameters of the two groups in relation to the degree of chronic prostatic inflammation. At the same time, we assessed factors exacerbating chronic prostatic inflammation.

Results: Comparison of the monotherapy and combination therapy groups showed no significant differences in the parameters of the urodynamic study or degree of chronic prostatic inflammation, whereas the IPSS total score, voiding subscore, nocturia, intermittency, weak stream, and straining were significantly lower in the combination than the monotherapy group. The duration of α-1 blockers administration was not correlated with the ratio of HEV-like vessels, while that of dutasteride was strongly correlated (correlation coefficient = 0.595; p < 0.001). Multiple regression analysis demonstrated that the duration of dutasteride administration was a key factor exacerbating the degree of chronic prostatic inflammation.

Conclusions: The present study showed that despite their ameliorating effect on prostatic hyperplasia, dutasteride contributed significantly to chronic prostatic inflammation.

Keywords: IPSS; alpha‐1 blocker; chronic prostatic inflammation; dihydrotestosterone; dutasteride; high endothelial venule‐like vessel.

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Conflict of interest statement

Naoki Terada is an Editorial Board member of International Journal of Urology and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication. The authors except for Naoki Terada declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
The correlation between the severity of chronic prostatic inflammation and each drug. (a) The length of dutasteride administration demonstrated a positive correlation with the severity of chronic prostatic inflammation. (correlation coefficient = 0.595; p < 0.001). (b) Duration of AB administration in all patients (correlation coefficient = −0.145, p = 0.081) and (c) The duration of ABs administration in patients receiving monotherapy (correlation coefficient = −0.073, p = 0.270) showed no significant correlation with the severity of chronic prostatic inflammation.
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