prostateI was recently reviewing an article in the New England Journal of Medicine which discussed a review of data from the Prostate Cancer Prevention Trial that was halted in 2003. The federally funded $73 million dollar study had originally been designed to evaluate if the drug finasteride reduced the risk of prostate cancer in men over 55 years old. It was stopped in June of that year due to the clear finding that it did indeed provide a significant benefit. A 25% reduction in risk was seen in men when the data was first released. However, there was at that time, also a concern related to a possible higher risk of higher grade cancers being discovered.

The study reviewed an additional ten years of data, following up on the original 19,000 male study participants. What it showed was that though there was a slight increase in higher grade cancers with the finasteride group, there was no increase in mortality. The higher detection rate is thought to be due to the prostate glands smaller size with the treatment and thus the increased ease of detection via biopsy.

Prostate cancer is a serious health issue in this country. More than 200,000 men in the United States are diagnosed each year, nearly 30,000 of who die. Among those are Arnold Palmer, Colin Powell, Dennis Hopper, John Kerry, Robert DeNiro. The list goes on of men in the public eye who have battled the disease; some ultimately triumphant and other succumbing to it.

The walnut sized gland encircles the urethra, the tube emptying urine from the bladder. As a man ages, the prostate tends to increase in size. This can cause the urethra to narrow and decrease urine flow. This is called benign prostatic hyperplasia or BPH, and it is not the same as prostate cancer. Finasteride has been used to treat this issue for years.

It’s now also been shown that the drug significantly reduce a man’s risk for developing prostate cancer. Though the safety of its use has been debated over the past ten years, this latest follow up suggests that there’s an even greater risk reduction with its use, along with the added reassurance from a safety standpoint on mortality.

So what exactly is this drug, finasteride, which can reduce a man’s risk of prostate cancer by a third? Finasteride, which is inexpensive and available generically, is a synthetic drug that blocks the normal metabolism of testosterone. This inhibition had previously been shown to reduce the size of the overall gland and thus it’s historical use for the treatment of its enlargement and the symptoms that come with its enlargement such as nocturia, frequency of urination at night.

As with all drugs, finasteride is not without risk of side effects. Some of those side effects may be considered positive, such as stimulating hair regrowth, and thus its use in the treatment of male pattern baldness. However, there is also a risk of sexual side effects for some that take the drug. And there is a concern for triggering depression in some patients and should thus be used with caution in anyone with a history for mood disorders. Additionally, it is a pregnancy category X, meaning it’s been shown to be toxic to a fetus, and thus should be stored carefully in any household with women of child bearing age.

Men may now be reassured however, that there is a inexpensive medication that can be taken to reduce their risk of prostate cancer, particularly important for someone with a family history. Even when a man survives prostate cancer the treatment of it often involves surgeries and radiation both of which cause significant side effects beyond the immediate costs. A 30% reduction in risk translates to almost 70,000 men each year in this country who can avoid fighting that battle. It’s important to point out the added value of annual screening for prostate cancer in men through medical exams and blood screening (a test called the PSA, or prostate specific antigen). I’d say it’s worth talking about. Particularly with your friends, family and loved ones. And of course your personal family physician.

Dr. Andrew Dale