Taking Propecia May Increase A More Aggressive Form of Cancer?

Dear Dr. Rassman,
I met with you last month at your office in L.A. and am planning to have a procedure this summer. You recommended that I take Propecia before and after my surgery to, 1) prevent “shock loss” and, 2) lower my risk of prostate cancer over the long term. As to the second issue, I’ve read the studies on the internet and they seem to say that while taking Propecia does reduce one’s chances of getting prostate cancer in the first instance, taking the drug may increase one’s risk of suffering from a more aggressive form of the cancer. How do you view these studies in terms of balancing the risks and benefits of taking Propecia over the long term?
Thanks

There is no doubt that Propecia will play an important role in preventing shock loss from a hair transplant surgery.

With regard to the cancer issue, the study that I am aware of shows what appears to be a more aggressive cancer with people taking Propecia, but that conclusion is based on the interpretation of the cancer by the way it looks under the microscope. The pathologists usually review the microscopic slides to determine how mean a cancer looks. The pathologist scores prostate cancers and classifies them based upon criteria establishing a Gleason Score, which tries to predict prostate cancer’s aggressive nature. The patients who had the high Gleason Score were followed since the diagnosis was made in 2001 and the cancers did NOT behave more aggressively than the cancers that were present in the placebo group studied at the same time. Anything can be agrued and this is just what is happening here. Two camps are squaring off so any absolute final word has yet to be written.

My conclusion (as well as many experts in the field of cancer) is that the Gleason Score is not reflective of the agressiveness of prostate cancer and that people who are taking Propecia are not at risk of developing an aggressive cancer more than the control group (made up of people not taking Propecia). For that reason, one of my sons and many members of my family are taking the drug.