Finasteride supported as chemoprevention in prostate cancer

Key Points

"After carefully reviewing the data from the landmark Prostate Cancer Prevention Trial, the thought leaders in the European urologist community agreed that the use of finasteride makes sense for those who are concerned about developing prostate cancer," said Per-Anders Abrahamsson, MD, PhD, chairman of the department of urology at Malmo University Hospital, Sweden, and secretary general of the European Association of Urology.

"With limited side effects, finasteride appears to have a dual benefit of treating the symptoms associated with benign prostatic hyperplasia and preventing prostate cancer," Dr. Abrahamson said at the International Prostate Cancer Update here.

Results from the PCPT showed that men taking finasteride, the type-2-specific 5-alpha-reductase inhibitor, had a 25% decreased incidence of being diagnosed with prostate cancer compared to men who took placebo. However, there also appeared to be a greater number of higher-grade cancers in men who took finasteride. The concern was that although the likelihood of developing prostate cancer was reduced in men who took finasteride, those who developed it appeared to have more aggressive disease.

More recent analyses of the PCPT data appear to have dispelled that concern, however.

"The data from the PCPT showed that finasteride changes the diagnostic accuracy of our two most frequently used screening tests-serum PSA and digital rectal exams-and that probably accounts for the slightly higher incidence of high-grade disease," explained Eric A. Klein, MD, head of the section of urologic oncology at the Cleveland Clinic's Glickman Urological and Kidney Institute.

"It is more likely that finasteride is unmasking a high-grade cancer that is already present, making it more likely to be diagnosed than [that it is] promoting higher-grade cancer."