Finasteride and Prostate Cancer

Q:

Hi doc I have a question.  I really need to get an answer towards this.

I am a propecia (finasteride 1mg) user for hairloss.  I just read an article regarding how the FDA recently(yesturday) rejected finasteride for use as a prostae cancer prevention due to the fact that finasteride sometimes increases high grade prostate cancers in  individuals who take it.  I am a bit scared since I am a healthy 25 year old who has been taking finasteride 1mg for a while and plan to to take it for hairloss.  Is it possible that finasteride can cause prostate cancer for someone who takes propecia for long term?  please help.  the article really freaked me out. I will post the link to the article below.

http://www.nytimes.com/2010/12/02/health/policy/02drug.html

A:

Finasteride is a DHT Blocker that is used both for prevention of male patterned baldness as well as prevention of prostate cancer.  There are several studies that evaluated the rate of prostate cancer in patients who take Finasteride long term.

The reported data from a recent Food and Drug Administration advisory committee evaluates available data on DHT blockers and whether or not the labels should stat that they decrease the rate of prostate cancer.

They evaluated results from two large studies of the drugs. GlaxoSmithKline’s study involved 8,000 men at risk for prostate cancer because their PSA (prostate specific antigen) tests had found elevations of PSA. The men also had prostate biopsies, but at the start of the study none had received a diagnosis of prostate cancer.

The Finasteride study, sponsored by the National Cancer Institute, was done on 18,800 healthy men over age 55 who were randomly assigned to take either the drug or a placebo.

Both above studies indicated the drugs reduced the overall prostate cancer risk by about 25 percent which is a significant improvement.  However, both studies also found small increases in the incidence of higher-grade, riskier cancers, in men taking the drugs as compared with placebos.

There are two suggested reasons for the increase in these numbers.  One is that the drugs reduced the size of a man’s prostate, making it easier to find lethal cancers on biopsies.  Also, both medications reduce the levels of PSA in blood making early diagnosis of prostate cancer in those patients difficult.

In summary we know that DHT blockers such as Finasteride (Propecia or Proscar) reduce the rate of prostate cancer, there are some reports on some slight increase in the higher stages of prostate cancer in patients who were on those medications.  Finasteride (1miligram) is still recommended for prevention of male pattern baldness.

I generally ask the patients who are over 50 to be tested for PSA before they start taking Finasteride.  I also stress that their family doctor be aware of the medication they are using so any slight increases in PSA are able to be taken more seriously (as opposed to people who are not taking the Finasteride medication).