use of dutasteride and finasteride for prevention

As many of you know, two studies have suggested that the drugs finasteride and dutasteride may reduce the risk of prostate cancer.  These are commonly referred to as the PCPT and REDUCE studies (PCPT involved finasteride and REDUCE involved dutasteride -- both of these drugs are 5-alpha-reductase inhibitors -- there are some differences between the two drugs, but I won't bother getting into that here).   These studies have led to a robust debate about whether these drugs should be prescribed for "chemoprevention" purposes, at least to high-risk people.  I have a great personal interest in this issue, since I am in that high risk category.  I have found the decision whether to take these medications to be extraordinarily difficult.  There are leading experts who say "you are nuts if you don't take it" and other experts of equal stature who say "doing this would be a terrible idea."  (I have received contrary advice even from doctors at the same institution!)  There have been articles written on both sides.  For those of you who might have any interest in this subject, I am attaching a link to a recent article which I found interesting because it is one of the very few articles I have seen that is balanced on the issue.  In reading this article, it is helpful to have read the study report and the Walsh editorial about the study report, but certainly not essential.   Best wishes, Medved

http://www.europeanurology.com/article/S0302-2838(10)00425-2/pdf/The+REDUCE+Trial

 

 

First of all they are the generic equivalents for Proscar and Avodart. There was a study of finasteride as a PCa preventative with mixed results.
What I can add to it is look below and you see I underwent a clinical study for TFT. A year after my treatment I had my first negative biopsy. Of 76 men who underwent all but 7 had negative biopsies, and those unlucky 7 with just one core positive. Of the 7 who didn't they were prescribed either drug and of those, 4 later had a negative biopsy. True it does lower the PSA so a new baseline must then be established. It's also true even with a negative normal biopsy doesn't mean it's in remission but along with no Psa rise it isn't aggressive at least.


Chemo is not done for any gland contained PCa I know of. I've been told the reason for that is chemo targets fast growing cells and unlike most cancerous cells PCa's grow to slow for it to be effective.

Purgatory said...
realziggy:

is the lowering of the PSA just masking it, or is it really lowering it period? i think that would be important to know.

Like I said the study had mixed results. Those guy who went through TFT had lower risk numbers to begin with and after just a single core positive gleason 6. As evidence it's anecdotal from my doctor. But he is on the cutting edge in new treatments. In fact he was on local TV again yesterday. He went with TFT by laser now. He's been doing that since January just as effective so far as my TFT with cryosurgery and it's even less invasive. Doesn't even require the cathetar I had for 4 days. Next time I see him I'll ask how the proscar/avodart is holding up on the men I mentioned.

I would consider taking the drugs near to AS as they are still being monitored and it appears having periodic biopsies too. Plus if nothing else it can help or prevent male pattern baldness as a side benefit.

"Chemoprevention" = use of drugs (chemical substances) for prevention. These are not the same drugs that are used for chemotherapy, such as taxotere, etc. Maybe the term "chemoprevention" is confusing, though it is a commonly used term in the medical literature. The point is that 5-alpha-reductase inhibitors may significantly reduce the likelihood of prostate cancer, but there is ongoing controversy. The AUA's clinical practice guidelines recommend that urologists discuss the use of these drugs, for preventative purposes, with their patients. That recommendation was formulated after the PCPT trial results were announced.

Purgatory said...
is the lowering of the PSA just masking it, or is it really lowering it period? i think that would be important to know.

The 5-Alpha inhibitors reduce the production of the prostate-specific antigen.  When a patient is tracking PSA results (velocity, doubling time), he needs to note the discontinuity between the "before" measurements and the lowered "after" measurements.