Finasteride to prevent prostate cancer a new chapter
There was great hope that they would be safe, easy, and effective chemoprevention agents against prostate cancer, but studies show otherwise. In this issue of The Oncologist, Kao and colleagues from Taiwan report on the most recent study that shows finasteride use was associated with an actual increase in risk of prostate cancer [ 3 ].
They identified 1, patients with cancer and BPH in the Taiwanese National Health Insurance registry and carefully matched three patients without cancer. The use of finasteride was associated with an increased risk of prostate and overall cancer prostate cancer risk increased with an odds ratio of 1.
Use of dutasteride was associated with no reduction in risk of prostate cancer and an increased risk of renal cancer. These disappointing results are in line with several other randomized trials investigating the use of these drugs for chemoprevention. The study reported a decrease of At the end of the study, the researchers asked participants who had not been diagnosed with prostate cancer to have a prostate biopsy to check for prostate tumors.
The updated results published in NEJM included up to 18 years of follow up on all trial participants, including prostate cancer incidence data for an additional year beyond the period previously reported and mortality rates for men in the trial, which the researchers gathered using data from the Social Security Death Index SSDI from the time the trial was stopped through October The SSDI does not provide information about the cause of death.
Results In the updated analysis, men taking finasteride had a 30 percent decrease in the relative risk of developing prostate cancer compared with men who took a placebo: This reduction in risk was explained solely by the prevention of low-grade cancers—those with a Gleason score of 6 or less—which present little health risk but, nonetheless, are often treated with radical surgery or radiation.
The risk of such cancers was 43 percent lower in the finasteride group than the placebo group. The men who took finasteride were more likely to be diagnosed with high-grade cancer compared with the men who took a placebo: The survival rates at 15 years were very similar between the two groups: Were there fewer cancers in these patients because finasteride actually prevents cancer or because fewer men got a biopsy in the first place?
In this study, 15 percent fewer men on finasteride underwent a biopsy because they were lulled into a false sense of security by their low PSA level. Thus, the major effect of this drug was to keep patients from knowing that they even needed a biopsy.
Of the men in the study who actually had a biopsy, the frequency of positive biopsies for cancer was statistically the same in patients in both test groups.
Walsh is very concerned about the increase in high-grade disease and the possibility that this presents an unacceptable risk for a form of treatment that has little or no value. Walsh noted that when patients on finasteride are diagnosed with prostate cancer, they are more likely to have dangerous, high-grade disease.
The real danger is that many patients will be lulled into a false sense of security. Risky Business for Two Patients Dr. Walsh has seen this risk in action in multiple patients. One man had a PSA of 3. Both of them had high-grade prostate cancer classified as Gleason 8 disease that had spread outside the prostate. One of them had a positive surgical margin.
Finasteride can reduce prostate cancer risk long term
Despite the increase in high-grade cancer, only five men died of prostate cancer in each group. The men were randomly assigned to take 5 mg of finasteride or a placebo daily for 7 years. Subsequent analyses of the PCPT data suggested that the observed increase in high-grade prostate cancers in men taking finasteride was due, at least in part, to improved detection. Both drugs have been proven successful in treating benign prostatic hyperplasia BPH and have been approved by the U. They identified 1, patients finasteride cancer and BPH in the Taiwanese National Health Insurance registry and carefully matched three patients without cancer. Walsh, if you want to prevent prostate cancer, finasteride is the last new you should take. This hormone influences the size of the chapter and can fuel the growth of prostate tumors. Finasteride hides higher-grade cancer The trouble with finasteride dates back to when the original article was published in the New England Journal of Medicine. The prostate of such cancers was 43 percent lower in the finasteride group than the placebo group. The updated results published in NEJM included up to 18 years of follow up on all trial participants, including prostate cancer incidence data for an additional year beyond the period previously reported and mortality rates for men in the trial, which the researchers prevented using data from the Social Security Death Index SSDI from the time the trial was stopped through October
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