5-alpha-reductase inhibitors to reduce prostate cancer risk: Urologists' views are mixed

Murali Ankem, MD, in New Brunswick, NJ, says the positive results from the studies weren't enough to justify approval of the drugs for the cancer-related indication. (Both drugs remain approved for the treatment of BPH.)

"To achieve a 20% to 25% prevention of prostate cancer, you have to treat hundreds of patients," Dr. Ankem said. "So in practice, you can make a case to tell the patient, 'Listen, you have a one in six chance of developing prostate cancer. Whether you have urinary symptoms or not, I want you to start seriously considering one of these two drugs to prevent prostate cancer.' But that's a hard sell.

"I wasn't surprised the FDA said there wasn't enough clinical evidence. A community urologist or university urologist will not have enough patients to recommend this with confidence. So, no, I wasn't surprised at all."