The effect of dutasteride on storage symptoms in men with lower urinary tract symptoms: a REDUCE trial analysis
Clinical Snapshot
PICO Framework
| P — Population | 8,122 men with lower urinary tract symptoms from the REDUCE trial |
| I — Intervention | Dutasteride (5-alpha reductase inhibitor) |
| C — Comparator | Placebo |
| O — Outcomes | International Prostate Symptom Score (IPSS) total score, voiding subscore, storage subscore, and nocturia at 2 and 4 years |
Bottom Line
This secondary analysis of the REDUCE trial demonstrates that while dutasteride significantly improves voiding symptoms within 2 years, its effect on storage symptoms is delayed (4 years) and clinically modest (0.62-point IPSS improvement). The authors appropriately conclude this improvement is unlikely to be clinically meaningful. For Australian clinicians managing men with predominant storage symptoms, dutasteride monotherapy appears insufficient. The evidence supports using dutasteride primarily for voiding symptoms in BPH, with additional therapies (anticholinergics, beta-3 agonists, or combination therapy) needed for meaningful storage symptom relief. This finding reinforces the importance of symptom-specific treatment approaches in LUTS management rather than expecting comprehensive symptom control from 5-alpha reductase inhibitors alone.
Key Findings
P Value: p < 0.001 for storage symptoms at 4 years; p = 0.09 at 2 years
Effect Size: 0.62-point improvement in storage symptoms at 4 years
Primary Outcome: Storage symptoms subscore at 4 years showed statistically significant but clinically modest improvement
Nnt Or Sensitivity: Not calculable from provided data
Confidence Interval: Not reported
Clinical Application
Dutasteride is readily available on PBS for BPH treatment, making implementation straightforward Aligns with RACGP guidelines for BPH management, though storage symptoms may require additional therapies like anticholinergics or beta-3 agonists available on PBS Australian men with benign prostatic hyperplasia and lower urinary tract symptoms, particularly those with predominant voiding symptoms
Abstract
BACKGROUND: Dutasteride is used to treat voiding symptoms; its impact on storage symptoms is unclear. METHODS: We reviewed 8122 men in the placebo and dutasteride arms from the REDUCE trial. Lower urinary tract symptoms outcomes were measured with international prostate symptom score and subscores. RESULTS: At 2-year follow-up, dutasteride significantly reduced the total International Prostate Symptom Score and voiding subscore versus placebo (both p < 0.001), but not storage symptoms (p = 0.09) or nocturia (p = 0.2). By 4 years, improvements in the total score and voiding subscores remained, but now extended to storage symptoms (p < 0.001) and nocturia (p = 0.003), though the impact on storage symptoms was modest (0.62 points improvement). CONCLUSION: While dutasteride reduces storage symptoms, it takes several years, and the overall effect is modest and unlikely to be clinically meaningful. Timely, comprehensive lower urinary tract symptoms management may require additional therapy.
References
- 1.Hernandez-Tirado, A., Zheng, R., Dadashian, E., Nik-Ahd, F., Moreira, D., & Freedland, S. J. (2026). The effect of dutasteride on storage symptoms in men with lower urinary tract symptoms: a REDUCE trial analysis. The Aging Male, Advance online publication. https://doi.org/10.1080/13685538.2026.2660387
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