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Proscar (finasteride) was the first FDA-approved drug in the treatment of BPH. It works by inhibiting the activity of an enzyme, 5 alpha-reductase, involved in male sex hormone (testosterone) metabolism. Proscar blocks the transformation of testosterone to dihydrotestosterone, a very potent hormone derived from testosterone, within the prostate. Dihydrotestosterone is responsible for the overproduction of prostate cells which ultimately results in prostate enlargement.
Although Proscar has received much attention, based on the results of the clinical trials, less than 37% of patients on Proscar will experience clinical improvement after taking the drug for one year and it must be taken for at least six months before any improvement can be expected. Meanwhile, about 5% of men suffer from decreased libido, ejaculatory disorders, and impotence while on the drug. Despite Proscar`s shortcomings and side effects, Merck, the manufacturer of Proscar, has predicted sales will soon reach $1 billion dollars annually.
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