Recent research indicates that 64% of urologists and 80% of primary care physicians surveyed do not prescribe finasteride for prevention of prostate cancer in high-risk men. These findings were recently published in the journal Cancer Epidemiology, Biomarkers & Prevention.[1]

Prostate cancer is a common cancer among men in the United States. The prostate is a walnut-sized gland that is located between the bladder and rectum. It is responsible for forming a component of semen. Due to the high number of annual deaths caused by prostate cancer, researchers have been trying to determine ways to prevent the disease. Androgens, or male hormones, play a role in promoting the growth of prostate cancer.

Finasteride is a drug that may be used for the treatment of benign prostatic hyperplasia (BPH) or male pattern baldness. Finasteride works by inhibiting the conversion of the male hormone testosterone to the potent androgen dihydrotestosterone; in doing so, finasteride reduces the size of the prostate. The main side effects of finasteride are reduced volume of ejaculate, erectile dysfunction, loss of libido, and enlargement of the breasts in males.

In 2003 researchers from several institutions conducted the Prostate Cancer Prevention Trial (PCPT) to evaluate the effects of finasteride on the development of prostate cancer.[2] This trial involved more than 18,000 men and included nearly 9,000 men who did not have prostate cancer at the initiation of the trial. The men were either treated with daily finasteride or placebo (inactive substitute) for seven years. The incidence of prostate cancer was reduced by approximately 25% in the group of men who received finasteride compared with those who received a placebo. However, among patients who developed prostate cancer, a larger proportion of men who received finasteride were reported to have a more aggressive form than those who received placebo. In 2008 researchers affiliated with the Prostate Cancer Prevention Trial conducted a reanalysis of the original large trial in order to evaluate whether or not finasteride was associated with the development of more-aggressive prostate cancer.[3] This updated analysis from the trial demonstrated that overall, patients treated with finasteride did not have a higher incidence of aggressive prostate cancers compared with those who received placebo. In addition, treatment with finasteride for seven years remained safe and generally well-tolerated and reduced prostate cancer risk by roughly 25%. In this updated analysis, the researchers concluded that the long-term use of finasteride appears to be an appropriate way to reduce the risk of prostate cancer among men who are at a high risk of developing the disease.

In the current study, researchers conducted a survey of 135 urologists and 464 primary care physicians within the Veterans Health Association (VHA) in order to determine whether or not finasteride was being prescribed to men who are at a high risk of developing prostate cancer. The researchers analyzed the questionnaire data to determine if the results reported in the updated PCPT data influenced prescribing decisions as well as to determine the barriers to prescribing chemoprevention for men at high risk of developing prostate cancer.

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  • 57% of urologists and 40% of primary care physicians indicated that they currently prescribe finasteride more frequently than they did five years ago.
  • Less than 2% of physicians indicated that the PCPT-reported data influenced their prescribing habits.
  • 64% of urologists and 80% of primary care physicians indicated that they never prescribe finasteride for chemoprevention. Fifty-five percent of urologists indicated they were concerned about the risk of high-grade tumors, and 52% of primary care providers were not aware that finasteride could be used for prevention of prostate cancer in high-risk men.

Finasteride has not been approved by the U.S. Food and Drug Administration for prevention of prostate cancer. Men at high risk of prostate cancer may wish to talk with their physician about the risks and benefits of using finasteride for this purpose.

References:

[1] Hamilton RJ, Kahwati LC, Kinsinger LS. Knowledge and use of finasteride for the prevention of prostate cancer. Cancer Epidemiology, Biomarkers & Prevention. [early online publication]. August 10, 2010.

[2] Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. New England Journal of Medicine. 2003;349:213-222.

[3] Redman MW, Tangen CM, Goodman PJ, et al. Finasteride does not increase the risk of high-grade prostate prostate cancer: A bias-adjusted modeling approach. Cancer Prevention Research [online publication]. May 18, 2008. 10.1158/1940-6207.CAPR-08-0092.