Dr. Catalona Responds
RISK USING PROSCAR OR PROPECIA
Q: What information do you have regarding the increased risk of high grade prostate cancer when taking Proscar or Propecia (finasteride)?
A: Proscar is in the family of drugs commonly used to treat or prevent benign enlargement of the prostate gland and to restore hair growth.
It inhibits an enzyme that converts the principal male hormone, testosterone, to its more potent form, dihydrotestosterone.
Thus, it is a mild form of hormonal therapy (lowering male hormone stimulation).
Proscar is in the news because a trial was just completed to see if Proscar would prevent prostate cancer in a group of men who started with a PSA less than 3 and with normal findings on their prostate examination.
The results seemed to show that in certain cases, proscar could be a preventative, but also among the findings was a disturbing conclusion showing the total number of high-grade (more aggressive and dangerous) cancers was higher in the men who received Proscar.
The results have been given different types of spin.
One is that Proscar prevents prostate cancer. But in my opinion, the study suggests that Proscar might mask the presence of prostate cancer for a time, allowing more aggressive cancer cells to develop. In addition, Proscar has adverse effects on sexual function in some men.
I would not recommend Proscar for preventing prostate cancer or even as a first-line therapy for benign prostatic enlargement or baldness (Propecia).
Other classes of drugs, called alpha blockers, are helpful in relieving the symptoms of an enlarged prostate in many patients, and they do not carry a risk of masking prostate cancer. Some examples of these are Flomax, Cardura, and Hytrin.