***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS The aim of this study was to assess patient outcome after discontinuation of alfuzosin treatment in patients with benign prostatic hyperplasia ( BPH ) . METHODS This study included 200 BPH patients .  Alpha-blockers were discontinued after 12 weeks of treatment when the International Prostatic Symptom Score ( IPSS ) was reduced to < 8 points , peak urine flow rate ( Q(max ) ) was increased to ≥ 15 ml/s , the postvoiding residual ( PVR ) urine volume was ≤ 100 ml and the patient agreed to discontinue treatment . Urinary symptoms of the patients were assessed at 4 , 8 , 12 and 24 weeks after discontinuation of medication , and surveys were performed asking whether patients wanted to restart administration of medication . RESULTS Of 200 enrolled patients , 142 ( 71.00 % ) received 12 weeks of treatment with 10 mg of alfuzosin . The medication was discontinued in 58 of 142 patients ( 40.85 % ) because urinary symptoms had improved . Among these patients , follow-up observations were performed for 49 patients up to 24 weeks after treatment discontinued . Of these 49 patients , 28 ( 57.14 % ) showed correct urination without a need to restart treatment up to 24 weeks after the medication was discontinued . The discontinuation group demonstrated improved voiding symptoms , including Q(max ) and PVR , relative to the re-administration group at baseline . Furthermore , the discontinuation group showed a smaller prostate volume than the re-administration group ( p = 0.045 ) . CONCLUSION When patients with BPH displayed symptomatic improvement upon treatment with alpha-blockers , the improvements were maintained in a select sub population of patients without the need to re-administer the alpha-blockers OBJECTIVE This study was conducted to examine the effect of discontinuing tamsulosin in patients with benign prostatic hyperplasia who had been receiving combination therapy with tamsulosin and dutasteride . METHODS The study sample consisted of 108 men with benign prostatic hyperplasia and lower urinary tract symptoms who visited our urology clinics between April 2008 and December 2010 . All were assessed using the International Prostate Symptom Score ( IPSS ) .  The patients had IPSS of 8 - 19 and prostate volumes ≥25 mL by transrectal ultrasonography . They were put on tamsulosin and dutasteride , and the efficacy of this regimen was assessed every 12 weeks . After 48 weeks , patients were divided at r and om into a group continuing to take the same drug combination ( group 1 ) and a group taking only dutasteride 0.5 mg ( group 2 ) . RESULTS Sixty-nine of the original 108 patients completed the study , 36 ( 52 % ) in group 1 and 33 ( 48 % ) in group 2 . The mean age of all patients was 67.96 ± 7.88 years and mean prostatic volume was 40.45 ± 12.81 mL. Mean prostate-specific antigen was 3.31 ( 0.4 - 9.9 ) ng/mL at the outset . The IPSS scores of the two groups at first visit , 48 and 72 weeks were , respectively , 14.69 versus 15.85 ( P = 0.322 ) , 12.08 versus 12.85 ( P = 0.582 ) and 10.89 versus 11.06 ( P = 0.897 . ) There was a statistically significant difference between the baseline and 72-week IPSS scores in both groups ( group 1 : P < 0.001 , group 2 : P < 0.001 ) . CONCLUSION In patients with moderate IPSS , discontinuing tamsulosin after 48 weeks of combined tamsulosin and dutasteride therapy has no significant effect on outcome OBJECTIVE To evaluate the long-term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia ( BPH ) . METHODS Thirty-three sites in 13 countries enrolled men with BPH who had an International Prostate Symptom Score ( IPSS ) > or = 12 [ corrected ] . After a 2-week , no-treatment lead-in period and a 26-week , single-blind treatment period , patients responding to terazosin were r and omly assigned to receive either terazosin or placebo for a 24-week , double-blind withdrawal period . RESULTS Of the initial 427 patients enrolled , 378 were evaluable , 273 of whom completed the single-blind period , of which 186 patients were r and omized . During the single-blind treatment period , IPSS , quality -of-life score ( QOL ) , peak flow rate ( PFR ) , and nocturia score ( NOC ) improved significantly ( p < or = 0.05 ) . During the double-blind withdrawal period , IPSS , QOL , PFR , and NOC deteriorated significantly in the placebo group compared with the terazosin group . The most common adverse event result ing in premature termination from the study was dizziness . There were no clinical ly important mean reductions in diastolic blood pressure ( DBP ) for patients normotensive at baseline . Terazosin significantly reduced mean DBP in hypertensive patients during the single-blind period and maintained the reduction during the double-blind period . CONCLUSION Treatment with terazosin has a beneficial effect on BPH , continuing for at least 12 months , and can be safely considered for medium- to long-term use in those who benefit Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To determine the safety and efficacy of intermittent alpha-blocker therapy in men with lower urinary tract symptoms ( LUTS ) in a prospect i ve study . Alpha-blockers have been demonstrated to be safe and effective in the treatment of men with LUTS . To date , the role of varying dosing regimens in responding patients has not been well studied . METHODS Men with LUTS were entered into this prospect i ve open label , parallel , r and omized trial . In phase 1 , patients were treated with alfuzosin , 2.5 mg three times daily for 3 months . In phase 2 , those patients who had a significant therapeutic response were r and omized into one of the following three groups : ( 1 ) maintenance of alfuzosin ; ( 2 ) alfuzosin every other day ; and ( 3 ) discontinuation of alfuzosin ( ie , no treatment ) . Patients were followed up for a total of 6 months . Parameters of evaluation included the International Prostate Symptom Score ( IPSS ) , global satisfaction , peak urinary flow rate ( Qmax ) , and adverse events . RESULTS At 3 months , there were 79 patients who were categorized as having obtained a therapeutic response :  IPSS decreased to 7.6 + /- 3.2 and Qmax increased to 11.3 + /- 2.9 mL/s . After r and omization , IPSS was 7.1 + /- 2.9 and 6.5 + /- 2.5 for group 1 ; 6.5 + /- 3.2 and 6.7 + /- 2.1 for group 2 ; and 11.4 + /- 4.8 and 12.3 + /- 4.9 for group 3 at 3 and 6 months , respectively . Qmax was 12.7 + /- 4.8 and 11.7 + /- 5.2 mL/s for group 1 ; 12.2 + /- 3.9 and 11.9 + /- 3.7 mL/s for group 2 ; and 9.7 + /- 2.5 and 9.3 + /- 2.1 mL/s for group 3 at 3 and 6 months , respectively . Global satisfaction at 6 months was the same for groups 1 and 2 . There were no differences in adverse events among the three groups . CONCLUSIONS In men with LUTS who responded to alfuzosin , changing the dosing regimen from daily to once every other day result ed in similar efficacy and safety at 3 and 6 months . By contrast , complete cessation of alfuzosin result ed in recurrence of both symptoms and impaired urinary flow . These data provide evidence that in responding patients , intermittent alpha-blocker therapy may be a reasonable therapeutic regimen . The role of intermittent alpha-blocker therapy using other agents , as well as in a large cohort of men with LUTS , remains to be determined OBJECTIVES To assess the results of doxazosin treatment in men with lower urinary tract symptoms ( LUTS ) treated for 15 months and to correlate symptomatic changes with alterations in urodynamic measures . METHODS After an initial 3-month treatment period with doxazosin 4 mg/day , 50 men with LUTS were given the choice of continued treatment with this agent or other therapeutic options . All patients were evaluated by International Prostate Symptom Score ( IPSS ) question naires and urodynamic evaluation initially and after 3 months of treatment . Patients were followed for an additional 12 months and those who continued doxazosin treatment underwent repeat urodynamic testing . RESULTS Among the original 50 patients , 24 men ( 48 % ) continued doxazosin treatment for 15 months , 18 men ( 36 % ) discontinued therapy , and 8 men ( 16 % ) were either dead or lost to follow-up or had been diagnosed and treated for prostate cancer . Comparison of values at 3 and 15 months of follow-up ( 9.4 versus 13.4 , P = 0.03 ) showed significant worsening of voiding symptoms , as assessed by the IPSS , in the 24 men still receiving doxazosin . This deterioration of subjective results with doxazosin occurred despite continued improvements in peak urinary flow rate ( Qmax ) , detrusor pressure at peak flow ( PdetQmax ) , and objective measures of obstruction ( Abrams-Griffiths number ) from 3 to 15 months of follow-up . CONCLUSIONS Relief of voiding symptoms in men with LUTS treated with doxazosin over prolonged intervals of 15 months does not correlate well with changes in urodynamic measures OBJECTIVES To evaluate the efficacy and tolerability of the selective alpha(1)-adrenergic antagonist doxazosin and the 5-alpha-reductase inhibitor finasteride , alone and in combination , for the symptomatic treatment of benign prostatic hyperplasia . METHODS In a prospect i ve , double-blind , placebo-controlled trial , 1095 men aged 50 to 80 years were r and omized to treatment for 52 weeks with doxazosin , finasteride , the combination of doxazosin and finasteride , or placebo . The dose of finasteride ( or its matched placebo ) was 5 mg/day . Doxazosin ( or its matched placebo ) was initiated at 1 mg/day , and titrated up to a maximum of 8 mg/day over approximately 10 weeks according to the response of the maximal urinary flow rate ( Qmax ) and International Prostate Symptom Score ( IPSS ) . The IPSS and Qmax were assessed at baseline and at weeks 10 , 14 , 26 , 39 , and 52 or at the endpoint . RESULTS An intent-to-treat analysis of 1007 men showed doxazosin and doxazosin plus finasteride combination therapy produced statistically significant improvements in total IPSS and Qmax compared with placebo and finasteride alone ( P < 0.05 ) . Finasteride alone was not significantly different statistically from placebo with respect to total IPSS and Qmax . All treatments were generally well tolerated . CONCLUSIONS Doxazosin was effective in improving urinary symptoms and urinary flow rate in men with benign prostatic hyperplasia , and was more effective than finasteride alone or placebo . The addition of finasteride did not provide further benefit to that achieved with doxazosin alone PURPOSE To revise the 2003 version of the American Urological Association 's ( AUA ) Guideline on the management of benign prostatic hyperplasia ( BPH ) . MATERIAL S AND METHODS From MEDLINE ® search es of English language publications ( January 1999 through February 2008 ) using relevant MeSH terms , articles concerning the management of the index patient , a male ≥45 years of age who is consulting a healthcare provider for lower urinary tract symptoms ( LUTS ) were identified . Qualitative analysis of the evidence was performed . Selected studies were stratified by design , comparator , follow-up interval , and intensity of intervention , and meta-analyses ( quantitative synthesis ) of outcomes of r and omized controlled trials were planned . Guideline statements were drafted by an appointed expert Panel based on the evidence . RESULTS The studies varied as to patient selection ; r and omization ; blinding mechanism ; run-in periods ; patient demographics , comorbidities , prostate characteristics and symptoms ; drug doses ; other intervention characteristics ; comparators ; rigor and intervals of follow-up ; trial duration and timing ; suspected lack of applicability to current US practice ; and techniques of outcomes measurement . These variations affected the quality of the evidence review ed making formal meta- analysis impractical or futile . Instead , the Panel and extractors review ed the data in a systematic fashion and without statistical rigor . Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases . Guideline statements concerning pharmacotherap 
    Output:
    
After discontinuing monotherapy , symptom scores increased and peak flow rates decreased at 3 and 6 months , but not at 12 months ; however , neither parameter changed when alpha-blockers were stopped during combination therapy .
Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy .
Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term .