The authors reply: Impact of metabolic syndrome on response to medical treatment of benign prostatic hyperplasia

To the editor: We express our special thanks for these nice comments on our published paper in your journal [1]. Our study was done before the release of the mentioned new guidelines in 2015 [2]. Moreover, there are studies that have also studied different outcomes (effect) of different durations of these medications on benign prostatic hyperplasia [3,4,5]. We were not able to study the maximal effect for more than 3 months. Because of the lack of previous studies with our design, we preferred to run a study with a shorter duration. In addition, our study was a cohort based on the present data and not a clinical trial with an arbitrary duration of study. Our treatment regimen contained both medications and we did not have a cohort of persons receiving only one of these medications. Perhaps in a factorial clinical trial with different groups consisting of only one of these medications, their combination and placebo could be useful for evaluation of the effect of each regimen. Surely, our results cannot be assumed to refer to only one of these medications but to their combination. In response to the comment, "In addition, the clinical effects of 5ARIs are seen after a minimum treatment duration of at least 6 to 12 months," we should note that in our study, the effects of combination therapy had been observed with a shorter duration. It may be that combination therapy is more effective with a shorter duration and that the effect of combination therapy with both finasteride and prazosin is different from their single treatment effect. Finally, our study was a clinical study and not a basic evaluation of the hormones. Accordingly, we prefer to not discuss these issues, even though the authors' opinions about hormonal pathways and changes seem logical. We think that these issues need a separate study evaluating the effect of all single or combination therapies on biochemical, hormonal, and enzymatic changes.