Rachid-Filho, D. et al. Treatment of recurrent priapism in sickle cell anemia with finasteride: a new approach. J. Urol. doi:10.1016/j.urology.2009.04.071

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Finasteride might be a safe and effective means of treating recurrent priapism in men with sickle cell disease. So say a group of researchers from the State University of Rio de Janeiro, Brazil. Rachid-Filho and colleagues studied 35 treatment-naive patients who used daily finasteride for 4 months, and found that the mean number of priapism episodes decreased with duration of therapy. Finasteride—a 5α-reductase inhibitor—is used in the treatment of benign prostatic hyperplasia, and might also have a role in the chemoprevention of prostate cancer.

All patients received 120 days of therapy with finasteride at 5 mg per day for the first 40 days, 3 mg per day for days 41–80, and 1 mg per day for days 81–120. At baseline, patients had a mean of 22.7 recurrent episodes per month; this rate decreased to 12.0 episodes per month at day 40, and 2.1 per month at the end of the study. After 4 months, 28 of the 32 patients who remained in the study had fewer than 5 priapism episodes per month. The investigators reported no acute episodes requiring surgical or hematologic procedures; adverse effects were limited to six patients who presented with painless gynecomasty.

A range of medical therapies have been used to treat recurrent priapism, but many are associated with emasculating metabolic adverse effects. Rachid-Filho and colleagues suggest that finasteride might be an effective means of treating these patients, with a seemingly favorable adverse effect profile. They note, however, that the long-term effects of finasteride on fertility in this setting remain to be evaluated.