Can Propecia delay early prostate cancer detection?"

[Jojo]

Hi,

This something i was thinking about lately and I was wanting to get your guys opinions on this, i did a quick google got a couple of quotes..

 

"To my knowledge there has never been any evidence linking the use of Propecia and the development of Prostate Cancer. There was a recent study that followed a large group of men taking Propecia for several years. The study showed that in addition to the slowing down of hair loss, men taking Propecia had a lower incidence of BPH (Benign Prostate Hypertrophy) and a lower rate of Prostate Cancer than the general population. However the few people who did develop Prostate Cancer had higher grades of Cancer. The authors reasoning for this is that Propecia helps to keep the Prostate gland smaller which in turn leads to a lower rate of Benign Prostate Hypertrophy (enlargement) converting to Prostate Cancer. For those patients whose predisposition for developing Cancer was so strong (higher grade of Cancer) the Propecia had no effect on them."

 

"The one thing to be aware of is Propecia® can lower the PSA in male adults. This is a blood test that is used to screen for prostate cancer in older men, usually above 50 years old. The test is still just as accurate in men on Propecia®." ( kinda sounds like there contradicting them selves there" ...So it sounds like if your taking Propecia it can be harder to screen for prostate cancer.

 

What do you think?

Edited October 18, 2010 by Jojo

[mahhong]

I am recalling from memory here and not a doctor or professional (in other words don't take my word as gospel!) but I believe that men taking propecia should tell their doctor before having a PSA. The doctor can factor in the fact that propecia lowers the PSA (and I believe they have a fairly good idea of how much propecia lowers the PSA) and can adjust the interpretation of the results accordingly.

 

In other words as long as the doctor knows you're taking propecia or finasteride in general you should still be able to get accurate screening.

 

As for the grade of cancer and a link to propecia, I'm not so sure. It would be very hard to set up a useful trial/research group that could accurately verify whether propecia was the cause of a general trend in higher grade cancers (but a lower trend in cancers overall). For example the higher grade cancer may be caused by factors not usually associated with 'normal' prostate cancer - in other words propecia is not causing anything at all, but that these men are developing higher grade cancer due to other factors (genetics, biological predisposition etc.).

 

I would hazard a guess that propecia doesn't cause higher grade cancers but that those cancers develop through different or further means that propecia cannot guard against. In other words, these men were unfortunately at a higher risk of developing high grade cancer and the propecia had no additional negative impact on that. Of course I'm not a doctor and this is an uninformed hypothesis, but statistics and trials often reveal trends that look as simple as "this" may cause a higher incidence of "that", but in reality the cause and effect are much more complex and the trial/research is simply demonstrating an anomaly rather than causing it.

 

Anyway, I'm rambling again! In short, propecia shouldn't make it harder to screen for prostate cancer and there is no evidence linking propecia to higher grade cancer that I know of (several trials have noted a correlation, but that is not evidence).

[mattj]

I believe the most recent information is very positive for Propecia users.

 

From wiki:

 

The 2005 Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5 mg per day, as is commonly prescribed for BPH, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo.[9] It appeared (incorrectly) that finasteride increased the specificity and selectivity of prostate cancer detection, thus creating an apparently increased rate of high http://en.wikipedia.org/wiki/Gleason_score http://en.wikipedia.org/wiki/Tumor. A 2008 update of this study found that finasteride reduces the incidence of prostate cancer by 30%. In the original study, it turns out that the smaller prostate caused by finasteride means that a doctor is more likely to hit upon cancer nests and more likely to find aggressive-looking cells. Most of the men in the study who had cancer — aggressive or not — chose to be treated, and many had their prostates removed. A pathologist then carefully examined each of those 500 prostates and compared the kinds of cancers found at surgery to those initially diagnosed at biopsy. This study concluded that finasteride did not increase the risk of high-grade prostate cancer.[10][11]

 

Finasteride - Wikipedia, the free encyclopedia

 

Wikipedia cites an article in the NYTimes:

 

http://www.nytimes.com/2008/06/15/health/15prostate.html?_r=1&ei=5087&em=&en=813eaa4e10f57756&ex=1213675200&adxnnl=1&adxnnlx=1213503418-GD4DbGjYsDxqV/xuGWnE1A

 

In summary, Finasteride appears to decrease the risk of prostate cancer overall, as well as potentially allow for easier detection of cancerous cells during a prostate biopsy, due to the reduced size of the gland.