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Fluke or Trend: 5ARIs vs Prostate Cancer

Posted Jun 28 2013 5:02am
It's been a while since I looked closely at 5 alpha reductase inhibitors.   In March 2011 , I discussed the potential side effects from taking a 5ARI.   In July 2011 , I reviewed two studies aimed at using a 5ARI as chemoprophylaxis against prostate cancer.  Unfortunately, the results didn't turn out as hoped and the Food & Drug Administration refused to give either finasteride or dutasteride approval for marketing as preventing prostate cancer.

Well, in a case-control study published 10 days ago in the British Medical Journal , the authors concluded that use of 5ARIs to treat lower urinary tract symptoms also lowered Gleason score 2-7 prostate cancer.  This was an expected outcome.  What was unexpected was that 5ARI use did not increase risk of Gleason 8-10 prostate cancer in the ensuing 4yrs.  Recall that while both the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial demonstrated that regular use of 5ARIs can lower prostate cancer risk by up to 1 in 4, they also increased high grade prostate cancer risk.  

So how does a guy decide?  Well, for now, use the 5ARI for its intended purpose, assuming you still need it.    That means take it for your receding hair line or because you have symptoms of an enlarged prostate.  But don't take it in an attempt to prevent prostate cancer.  At least not until we have better research to support such an indication.


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