THURSDAY, Aug. 12 (HealthDay News) -- Even though a major study
found that the drug finasteride could reduce the risk of prostate
cancer by 25 percent, it is still not being widely prescribed for
that purpose, Veterans Administration researchers report.
Under the name Proscar, finasteride is commonly prescribed to
treat the non-cancerous condition called benign prostatic
hyperplasia, also known as enlarged prostate. Finasteride is also
sold under the brand name Propecia, to help treat male pattern
In 2003, the Prostate Cancer Prevention Trial (PCPT), involving
more than 18,000 patients, found that finasteride cut the incidence
of prostate cancer by 25 percent -- the first drug to do so.
But a much-publicized follow-up analysis undercut that good news
when it suggested that the drug might actually boost the odds of
particularly aggressive prostate tumors.
At the time, "there was a concern that [finasteride] may have
made worse the number of cases of more severe prostate cancer,"
explained the lead researcher of the new study, Dr. Linda
Kinsinger, chief consultant for preventive medicine at the Veterans
Health Administration National Center for Health Promotion and
Disease Prevention in Durham, N.C.
Upon a re-analysis of the data, however, that uptick in risk for
more aggressive tumors turned out to be false: finasteride did not
raise the risk for an aggressive tumor, it simply helped make
prostate screening more sensitive, so these tumors were spotted
But the reassuring results of that 2008 re-analysis may not have
trickled down to doctors and patients today, Kinsinger's team
reports in the September issue of
Cancer Epidemiology, Biomarkers & Prevention.
Instead, too many doctors remain wary of prescribing
finasteride, so the numbers of prescriptions written to help
prevent prostate cancer hasn't budged for years.
That's unfortunate, Kinsinger said, because "there does seem to
be a benefit and it could be more widely used."
In the study, her team surveyed 325 urologists and 1,200 primary
care doctors on their prescribing practices.
Among the doctors surveyed, 57 percent of urologists and 40
percent of primary care physicians said they prescribed finasteride
more often, but only 2 percent said the PCPT trial results had
influenced their decision.
Moreover, 64 percent of urologists and 80 percent of primary
care physicians said they never prescribed finasteride with the aim
of helping to prevent prostate cancer.
Asked why, 55 percent said they were worried about the risk of
the drug causing high-grade tumors, while 52 percent said they
simply had no idea that finasteride could be used to prevent
The study was funded by the VA National Center for Health
Promotion and Disease Prevention and the U.S. Department of Defense
- Prostate Cancer Research Program.
Although the doctors in the survey all came from the VA medical
system, Kinsinger said these results most likely mirror what is
happening throughout the United States.
Besides doctors being poorly informed about finasteride,
patients' psychology probably plays a role as well, Kinsinger said.
"As a healthy person, why should I pay to take a drug that has some
chance of causing me side effects to prevent something that I may
or may not get down the road?" she said. "I think that's a tough
Another problem with the drug is who would benefit from taking
it, Kinsinger said. Men most likely to benefit from finasteride are
those at highest risk from prostate cancer, such as men with a
family history of the disease, she explained.
"But we are not very good at narrowing the universe of men down to the subset of those who are actually at higher risk of developing prostate cancer," Kinsinger said. "If we could develop a means of identifying people who are truly at the highest risk for developing prostate cancer that would ideally be the target group, but we don't really know who those people are yet."
Prostate cancer expert, Dr. Anthony D'Amico, chief of radiation
oncology at Brigham and Women's Hospital in Boston, agreed that the
fear of adverse consequences of finasteride has made doctors
reluctant to prescribe it.
"The bottom line is that despite all the well-designed and well-thought-out studies to explain why high-grade prostate cancer was increased, while low-grade prostate cancer diagnoses decreased with finasteride use in the PCPT, physicians remain hesitant to prescribe finasteride as a preventive agent," he said. "And so the observation in the VA system in the current study supports the sentiment I have heard when traveling around the country and teaching on this topic."
So the path forward may be difficult, he said.
"The way it's thought of is 'If I take this drug I am going to prevent a prostate cancer that may or may not need treatment. I am going to increase my risk, to a very small degree, of a cancer that may not be curable,'" he said. "And that's how people read it."
For more information on prostate cancer, visit the
American Cancer Society.
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