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Finasteride provides an alternative to the traditional ‘watchful waiting’ approach for patients with mild or moderate benign prostatic hyperplasia (BPH). Previously, the only option was to rule out other diagnoses (principally prostatic cancer) and then monitor patients until symptoms became severe enough to require surgery.Now there are several drug treatments for patients with symptoms severe enough to affect their quality of life but not severe enough to warrant surgery.Of these alternative agents, finasteride appears to be the best tolerated. However, it does not produce improvements as rapidly as the α1-adrenoceptor blockers and the clinical benefit is modest with both. Around 50% of finasteride recipients have some improvement in urinary flow, but the increase is generally of marginal clinical significance.Treatment must be lifelong if benefits are to be sustained. Therefore, cost may be a limiting factor of finasteride therapy for some patients, especially as α1-blockers have lower acquisition costs.