Avodart - finasteride A New Study

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geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 4/1/2010 8:12 AM (GMT -6)   
In today's news there were popular accounts of a study published in the New England Journal of Medicine. I found two articles with rather opposite spins:

"Avodart may promote some tumor growth"
www.philly.com/philly/health_and_science/89666907.html


"Prostate drug may work as a preventive"
www.latimes.com/news/nationworld/nation/la-sci-prostate1-2010apr01,0,2741240.story?track=rss

The citation to the study is:
NEJM v.326 n. 13 pp 1192-1202 (April 1, 2010)
Effect of Dutasteride on the Risk of Prostate Cancer

The abstract, but not the entire article is available at:
content.nejm.org/cgi/content/short/362/13/1192
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/1/2010 12:32 PM (GMT -6)   
Thanks for posting these, geezer. Worth reading by anyone interested in expanding their knowledge on PC treatment. [The paper is new, but I thought I had read this previously; maybe a pre-publication release.]

Interesting, however, that the Times article (the 2nd article) barely makes mention of the downside, but a discussion of the downside makes-up about 50% of the Philly article. Thanks for posting both!

1-sentence summary of the articles: Avodart/Finasteride are commonly prescribed today for BHP but have also been shown to cause small tumors to stop growing or shrink in some patients, but they also artificially lower PSA which can mask an aggressive tumor (in the small percentage of men with tumors of an aggressive biology).

DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 818
   Posted 4/1/2010 2:30 PM (GMT -6)   
I just read about this from a Google link. Sounded like these are similar to HT, with similar side effects. Anyone have any experience with these?
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)
4/23/09, 07/30/09, Oct 2009, Nov 09, Feb 10 still undetectable (<0.01)!


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/1/2010 3:26 PM (GMT -6)   
DJBearGuy said...
I just read about this from a Google link. Sounded like these are similar to HT, with similar side effects. Anyone have any experience with these?

I'll be treading in waters that I'm not very familiar with, but certainly the next person to chime in will have direct experience and can give a better answer.
 
What I understand is that finesteride is one part of the HT "triple blockade" regimine to block almost all or most of the conversion of testosterone to DHT.
 
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/1/2010 3:38 PM (GMT -6)   
Casey, I worry about anything that can mask a true PSA reading. My GP and I had a good discussion on that one day in the past, thats why he's concerned about certain supplements and other OTC treatments. The drug mentioned, makes it so hard for anyone reading these kinds of reports, which version to believe. And I bet if I asked 3 different drs, get at least 2 opinions. Makes it hard on a lay person to know what to do sometimes.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/1/2010 3:57 PM (GMT -6)   
Yes it is used by patients as hormone therapy and part of ADT3 combo as mentioned, if doing the Leibowitz protocol (under say his guidiance) he would know if you need to switch. It is used as maintenance drug by Leibowitz and others, after going off ADT3, then ADT1 via proscar or avodart (avodart is more potent). Usually little to no side effects that are worrisome, the t.v. ads mention possible breast enlargement, which they did not mention this at all years ago. You can also get that side effect on casodex, DES and estrogenic drugs, there are ways to combat that, too. So it does not have to happen with planning ahead.

My guess as why this dichotomy on good or possible bad using proscar/avodart/etc., is probably not the drugs fault as we need to remember these variables: 18 variant types of PCa, 3-different types of Ploidity (DNA structures) on every type of PCa known. They don't all respond the same, some types don't hardly work with hormone therapies (that is the scariest scenario and is worrisome), these are usually rarer in patients is the good news. The case you hear of like Frank Zappa died of PCa and PSA was only around 1.0 (well some of these worst type variants are agressive and don't give off PSa to measure, this is why other tests run by Onco-doc's is superior for the patient and having expert pathology should be a necessity, only about 6 guys are mentioned by Dr. Strum and I am sure it is with good reason, he knows PCa and patients and scenarios...well. As I have mention PCa is more like the Twlight Zone, Limbo Land, Jungle...you name it...no rules are easily identified.


Youth is wasted on the Young-(W.C. Fields)


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 4/1/2010 7:22 PM (GMT -6)   
Geezer,  thanks for posting the links.  I used finasteride off and on for several years to treat BPH.  It provided modest urinary relief, promoted hair growth, and cut my PSA in half.  We simply doubled my PSA numbers while I was using it.  I finally stopped using it because it just didn't help much.  The last time I stopped the finasteride, my PSA climbed rapidly.  So, one could argue that the finasteride either caused my agressive PCa or maybe kept it in check for a while.  I personally don't believe it made any difference.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 4/1/2010 7:23 PM (GMT -6)   
I was on Avodart during my breif AS stage, and there is another reason to avoid AS, if they are going to pump you with drugs.  I didn't ike it, it was an erection killer and gives you man  boobs, and it is very expensive.  Didn't help much, now after surgery I pee like a race horse, pure heaven.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 4/1/2010 8:15 PM (GMT -6)   
I was on Proscar for about three years. PSA immediately dropped by 50%, but kept rising at the same PSADT rate as before. The rate of psa increase is much more important than one reading of psa. After taking proscar you simply establish a new baseline.
There are some side affects; small loss of libido.
I developed tender breasts and some lumps after taking it about 2/12 years. Went away in a couple of weeks after I stopped.
It is commonly used in ADT3 along with Lupron and Casodex as a total hormone blocking treatment and if used during the time off HT it increases the length of the off periods.
I also took it for 6 months along with casodex in order to shrink my prostate before seeding. Prostate shrunk from 60mm to 32 mm in 3 months. A positive side affect was it grew a lot of hair.
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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/1/2010 8:52 PM (GMT -6)   
Just about all of you touched upon the downside which is risky...the PSA masking.

The Philly article discusses the cautions AGAINST wide useage of Finasteride in a PC preventative mode — prescribed like cholesterol meds, was the parallel example — which could lead to a relatively loosely controlled environment.  Use of Finasteride needs to be closely monitored because of the PSA masking.

Each one of you that mentioned this commented on how you adjusted for this while under close doctor supervision...usually by doubling the PSA. The point being that, despite the findings in this report, we can't just start prescribing it to everyone so that everyone can prevent PC tumor growth.

The Times article totally missed this important point, and focused (in the irresponsible manner that the mass media tends to do) on the more narrow aspect of stopping or shrinking tumors.

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/2/2010 6:10 AM (GMT -6)   
From everything I've read, Proscar/Avodart work best as part of the ADT3 combination and as maintainace when off the other two drugs.
 
I kinda snicker when I read about trial failures on these drugs (Avodart/Proscar). My bet would be any hormonal blockage agent would have failed in those cases; its only natural that more aggressive cancers are likely to fail hormonal therapy sooner than less aggressive cancers. That being said, the observation that LESS aggressive cancers appeared in the placebo group actually puts some credence that hormonal ablation does not extend life. I personally do not agree with that but there certainly may be more to this that still needs to be clarified.
 
I still believe, that at the end of the day, estrogen may very well be the best treatment for those whose initial/salvage treatments have failed. It is also much cheaper than the hormonal ablation drugs but does require monitoring due to possible cardio-vascular implications. More research needs to be done on estrogen. We already know that they are effective at lower doses than previously thought; this is something that automatically lessens their cardio-vascular impact.
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


Arno
Regular Member


Date Joined Apr 2010
Total Posts : 54
   Posted 4/3/2010 6:58 AM (GMT -6)   
I will be asking for Proscar in addition to the Zoladex + 150mg Casodex I have for the last half year. I hope that it might be possible to have an off period after another 9 months or so. Does anybody know if this is possible when you had extensive metastases in the bones ? Leibowitz advocates ADT3 and keeps giving the Proscar in an off period.
-
Diagnosed at age 63 Sep'09: PSA 575, GS 7 (4+3)
bone scan: as a fully lit christmas tree
With Zoladex+150mg Casodex PSA <0.1
Additional: Zometa

Post Edited (Arno) : 4/3/2010 6:07:44 AM (GMT-6)


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/5/2010 8:33 AM (GMT -6)   
Arno,
 
I'm not a doctor so I can only give you my opinion. That is, with significant bone metastasis, you may not want to consider letting the wolves out, even for a peek, when they are under control. I know that you would love to have a break but.....
 
BTW: the drop in your psa to less than 0.1 IS something to be happy about. I hope it continues indefinetly.
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/5/2010 1:50 PM (GMT -6)   
The issue of using finasteride or dutasteride for chemoprevention (as opposed to other uses, such as a part of ADT3 or as a "maintenance" drug during an "off period") is one I am very interested in -- as someone who does not have CaP (as far as I know), but has a family history and high risk.   I have read everything I can get a hold off on this topic, and have raised the issue with leading urologists and medical oncologists, and have reached the conclusion that there is simply no consensus.  The advice I have gotten has ranged from "you are nuts if you don't take dutasteride" to "it would be dangerous for you to take dutasteride."  I even got opposing advice on this question from two urologists at the same (very highly regarded) institution.  Sometimes -- unfortunately -- medicine is not as black and white as we would like it to be.  
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 

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