Health authorities must audit use of finasteride

Editor—Andrew Farmer and Jeremy Noble are right to draw attention to the results of a recent trial which showed that finasteride, a 5α-reductase inhibitor, was little better than placebo in a group of men with moderate symptoms of benign prostatic hyper- trophy.1 2 The mean prostatic volumes in this trial were in the range 36.2-38.4 cm³, which is lower than the volume in other, more positive, trials that have assessed the efficacy of finasteride.3

Health authorities have a duty to ensure that prescribing is both clinically and cost effective.4 One can deduce, therefore, that the use of finasteride in men with moderate symptoms of benign prostatic hyperplasia and moderately enlarged prostates is neither. Moreover, expenditure on finasteride by health authorities is considerable. We have examined expenditure on and prescribing rates for finasteride in our district over the past two years, using the health authority …