Finasteride for prevention?

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Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 7/19/2009 5:58 PM (GMT -6)   
I'm curious about Finasteride, as a preventive measure for prostate cancer. I've written to Dr Catalona a while ago regarding this subject and he was against using Finastride as a prevention measure. He had written a Quest article about it (pasted below), this was written in 2008 and I believe a second study looked at the results and declard Finasteride *does not* increase the chance of aggressive PCa.
 
What is your opinion regarding Finasteride?
 
 
 
Any treatment that reduces androgen effects is considered “hormonal therapy,” because many, but never all, prostate cancer cells cease to proliferate or die when androgenic stimulation is substantially reduced.
A central question, therefore, is whether taking finasteride is true “chemoprevention” or whether it is merely a weak form of early hormonal therapy that masks and delays the detection of prostate cancer.
 
An alternative hypothesis to finasteride providing true chemoprevention of prostate cancer that is consistent with the available data is as follows:
(1) Finasteride cannot prevent prostate cancer; it merely delays progression of low-grade prostate cancer;
(2) Finasteride suppresses the growth of normal prostate tissue, benign prostate hyperplasia tissue, and low-grade prostate cancer cells, but cannot control aggressive, high-grade cancer, and eventually, if given time, high-grade cancer will emerge.
 
In a clinical trial with longer follow-up (15 to 20 years), it is possible that “masking” high-grade prostate cancer with finasteride until it is too late for cure might outweigh any benefits from delaying or preventing the detection of lower-grade cancers.
If a prostate cancer chemoprevention study has a limited time span of 7 years, a delay in cancer detection would produce the appearance of a decrease in cancer incidence. However, with longer follow-up, this apparent benefit would substantially diminish or disappear.
 
This situation was, in fact, the case in the Prostate Cancer Prevention Trial among patients who had a biopsy “ for cause” or after an interim procedure, such as a transurethral resection of the prostate for presumed benign enlargement of the prostate. Among the men who were biopsied seven years after randomization (They biopsied 7.1 % of men in the placebo arm and 7.0% in the finasteride arm.), a nearly equal number of cancers (124) in the placebo arm and in the finasteride arm (122) were diagnosed; however, 64 (52%) of the cancers in the finasteride arm were high-grade as compared with only 38 (31%) in the placebo arm.
 
My Recommendations
Until further information is available, I recommend only the FDA-approved use of finasteride in men with severe symptoms from benign prostatic enlargement that have not responded to alpha-blocker therapy (such as Flomax) and want to delay surgical intervention for relief of urinary obstruction.
I warn them that finasteride might mask high-grade prostate cancer.
I recommend a prostate biopsy to rule out cancer before starting finasteride, and I recommend a repeat biopsy if the PSA rises while the patient is on finasteride treatment after I have ruled out other possible causes for the PSA increase.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 7/19/2009 10:17 PM (GMT -6)   
Others that have reviewed the study came to the conclusion that the agressive group was a case of pure mathematics. Fenistride reduces the size of the prostate therefore a biopsy sample against a normal prostate should give more positive samples of agressive cancer.
Finisteride cuts psa about 50% and slows its growth so it may be the case that it will mask some cancers that would have been picked up by psa rise.
Like everything else in the PC world there is disagreement among experts. There are studies that show that Finistride can reduce PC by 25% if taken as a preventative. It is also used in intermittant Hormone Therapy during the off period as it increases the time that a patient can stay off Hormones.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT

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