Comparative Effectiveness and Safety of Finasteride and Dutasteride in the Treatment of Benign Prostatic Hyperplasia: A Real-World Retrospective Study

Background and Objectives: Benign prostatic hyperplasia (BPH) is one of the most common chronic conditions in older men, significantly affecting quality of life (QoL) by causing lower urinary tract symptoms (LUTS). 5-alpha-reductase inhibitors (5-ARIs) such as finasteride and dutasteride remain a cornerstone of pharmacotherapy for BPH; however, comparative real-world data are limited. The aim of the present study was to compare the therapeutic outcomes of finasteride and dutasteride in patients diagnosed with BPH. Materials and Methods: This retrospective clinical study analyzed patients with BPH treated by either finasteride or dutasteride. Clinical parameters, including the Interna-tional Prostate Symptom Score (IPSS), QoL index, and International Index of Erectile Function-5 (IIEF-5) score; urodynamic outcomes, including maximum urinary flow rate (Qmax), average flow rate (Qave), and post-void residual urine volume (PVR); and bi-ochemical markers, including prostate-specific antigen (PSA) and creatinine levels, were assessed at baseline and after at least 6 months of continuous therapy and underwent cross-sectional statistical analysis, with significance set at p < 0.05. Results: Both treatment groups demonstrated significant improvements in clinical and urodynamic outcomes. Compared with finasteride, dutasteride was associated with greater reductions in the prostate volume and PSA levels as well as a greater im-provement in “IPSS”. Erectile function (IIEF-5) was comparable. Renal function param-eters remained stable in both groups. Predictive analysis revealed that higher body mass index and older age correlated with worse IIEF-5 scores in the finasteride group, whereas the baseline prostate volume was the key differentiating factor in the dutasteride group. Conclusions: Both 5-ARIs effectively reduced the severity of LUTS and improved uro-dynamic parameters in patients with BPH. Dutasteride showed superiority in reducing the prostate volume and PSA levels, while the overall safety profiles of both drugs were comparable. These findings highlight the importance of individualized therapy tailored to patient-specific clinical characteristics.