More Opinions About Finasteride and Prostate Cancer Risk
This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).
E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:
“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].
In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”
We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.
The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.
I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.
You have not made it clear why you would prefer to prescribe drugs for hairloss rather than a surgery. It is safer in every way to administer a hair transplant. Perhaps you realize that patients will opt out of treatment altogether since many men would never consider the very significant and costly method of pursuing a transplant?
As additional points, I would encourage readers and especially physicians to read the study and the FDA Advisory Committee meeting minutes where this issue is discussed (related to the decision not to allow Merck to expand their label to include a indication of reduced prostate cancer). This info (links previously provided on this blog) is publicly available. Again, everything has risks. Viagra and Cialis have been taken by over 80 million men bout their labels note a risk of (potentially irreversible) blindness alled NAION and hearing loss, phenomena that occur in about than 1-2 times in 1 million users (and is still not known to be related to the drug or the underlying conditions that the patients have).
Good point BiotechMD
which point, Jeremy #2? He made more than one.
I’m not sure why there is an impostor that is attempting to impersonate my name.
I understand the argument of Mangubat and it is quite logical but it is based on many unstated assumptions that are unverified. He does not provide any evidence to back up his claim that finasteride saves lives in those who would have otherwise developed low-grade prostate cancer. There has not been an investigation into fatality statistics, as Dr. Rassman mentioned, which is completely necessary before drawing the absurd comparison to seatbelts.
I would not trust a cosmetic surgeon for medical advice related to proper health issues, but that is my personal opinion.
This point:
Again, everything has risks. Viagra and Cialis have been taken by over 80 million men bout their labels note a risk of (potentially irreversible) blindness alled NAION and hearing loss, phenomena that occur in about than 1-2 times in 1 million users (and is still not known to be related to the drug or the underlying conditions that the patients have).
I don’t want my type II 5-alpha reductase blocked my some drug. It is there for a reason and serves an important function. Several hundred thousand years of human evolution put it there for a purpose and we are nuts thinking that fiddling with it for a little extra hair on the head will be without consequence.
That is the most sensible thing I’ve ever read on this blog. It comes down to pure common sense (which as we know a huge swathe of people sadly lack)
How can anybody in their right mind tell me with a straight face that taking an androgen blocker isn’t going to have adverse effects on the male human body?
I was not attempting to impersonate you, Jeremy. My name happens to be Jeremy as well.
Tex – A risk-benefit analysis is not the same as a pro/con chart. I’m not going to delve any deeper into the weaknesses of your decision making skills but they are two distinct concepts.
Additionally, nobody said the FDA was corrupt and hiding PFS. They are an underfunded, bureaucratic institution that has difficulty attracting the best employees. This does not prove or disprove anything about PFS. The evidence of the connection between finasteride and prostate cancer has been around a long time. As I mentioned in the past, if you took the initiative, you could (not so easily) access the FDA’s database and find very convincing proof that PFS exists in addition to the many health problems it has caused by ways of birth defects amongst others. Undoubtedly, it will come out that PFS exists and is accepted by each and every responsible doctor but the timescale on which this will happen is unknown.
Lastly, Johnny’s analogy is not comparable on many levels. Too tired to further elaborate but it is not like refusing to fly a plane for fear of being in a crash.
I didn’t ask you Steve. Are you guys friends or something?