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Finasteride and prostate cancer prevention: an opportunity for advocacy

Posted Sep 28 2008 5:40pm

Today’s New York Times article (right on the front page) is going to “heat up” the finasteride debate. With the key editorialist (Peter Scardino, MD) changing his opinion, the PCPT trial results are now clear: finasteride does reduce risk for prostate cancer by 25-30 percent, and does not increase risk for aggressive disease. (For those who have not seen the most recent analysis by Thompson et al., please click here.)

The question now becomes, who should be taking finasteride?

Medical “conservatives” have already (and correctly) noted that despite the effects of finasteride as a preventive agent, its widespead use will still only prevent a small percentage of aggressive prostate cancers that really do need to get treated (as compared to a significant number of nonaggressive prostate cancers that could probably be managed extremely well by active surveillance).

The place where we would argue that there should be no issue is in the prevention of prostate cancer in those who are already at high risk. This includes those who meet one or both of the following criteria:

  • Men with a family history of prostate cancer (and particularly those with a family history of high grade prostate cancer)
  • Men with a “baseline” PSA level of 1.0 or higher taken in their 30s.

It is going to take significant time for the medical community to sort out their recommendations based on the revised assessment of the results of the PCPT trial. However, the prostate cancer advocacy community can and should move quickly.

The “New” Prostate Cancer InfoLink strongly recommends the immediate development of a brief position paper by the advocacy community that lays out in no uncertain terms the criteria that define men at specific risk who should start taking finasteride as an agent for the prevention of prostate cancer.

Quite apart from its value to those patients, such a position paper would also act as a stimulus to the medical community to issue their own guidelines and to the payer community to make decisions about coverage of finasteride for this use.

Filed under: Prevention

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