Prostate Cancer and 5AR Inhibitors, Again
I’ve received a few emails directing me to the a publication in the New England Journal of Medicine from last month regarding finasteride, dutasteride, and prostate cancer reduction. We’ve written about this issue here and specifically, albeit briefly, about this NEJM piece here. So I’ll take the opportunity to highlight it again, since people are still finding their way to the article.
The authors’ take on the relationship between the use of these drugs (finasteride and dutasteride) and the risk/benefit relationship on prostate cancer concluded that the original reports of a cancer reduction in the studied men (about 10,000 men who received finasteride 5mg dose) showed that the lower risk was found only in men with low grade cancers. If men had a high grade cancer, they felt that there would be no benefit to taking these drugs and suggested a possible harmful risk that is clearly ill-defined at this time. On the basis of this conclusion, the use of finasteride or dutasteride as a preventative medication for prostate cancer is claimed not to be justified.
The FDA came out echoing this sentiment. It appears that “the labels of approved 5α-reductase inhibitors, which are currently indicated for the treatment of symptomatic benign prostatic hyperplasia and male-pattern hair loss, have been modified to include the observation of high-grade prostate cancers” found in the relevant trials.
I am sure that one result of this formal, official FDA change in position is that some men will consider abandoning the use of these drugs. I will be attending the annual ISHRS physician meeting in September, where this subject will be discussed amongst many doctors who are concerned about this announcement. I’ll be curious to learn about patient reactions to the FDA’s position.
It is nice to know you will be looking into this issue at the ISHRS conference, but are you really going to find the most reliable answers by asking a handful of hair surgeons rather than asking doctors with more relevant specialties like urologists, oncologists, or even epidemiologists?
Dont forget that there is a biologic model for finasteride users; a group of people with a 5 alpfa reductase deficiency who never went bald neither did they developed prostate cancer – and reached high age without much further difficulties. And dont forget that most people who are having all kinds of problems do not use medications. I would like to thank the makers of finasteride (and probably dutasteride)on the behalf of millions of people around the world for ‘saving’ their lives!!