Propecia is a low-dose version of the drug finasteride, and is used by men who want to slow, stop, or reverse male pattern hair loss.
Finasteride is also prescribed under the name Proscar at a higher dosage for treatment of an enlarged prostate. The National Cancer Institute (NCI) sponsored a Prostate Cancer Prevention Trial (PCPT) starting in 1993. Results from ten years ago showed that finasteride significantly reduced the risk of prostate cancer.
However, among those who did develop prostate cancer, the drug was associated with a higher risk of high-grade prostate cancer.
Until recently, it was unclear what this association between finasteride and high-grade prostate cancer meant. Since 2011, finasteride has had to bear a warning label about the possible increase in the risk of high-grade prostate cancer, and the drug has never been approved for preventing prostate cancer despite the reduction in risk for low-grade prostate tumors. Recent study results, however, are elucidating the role of finasteride in prostate cancer prevention … and the news is good.
The Latest Study Results
Results published in the New England Journal of Medicine on August 15 are based on a follow-up of PCPT participants after 18 years. This follow-up showed that survival for men taking finasteride was equivalent to men who didn’t take the drug, and that the reduction of risk in prostate cancer among men taking the drug was real. In fact, finasteride could prevent up to 70,000 cases of prostate cancer, along with the unpleasant treatment regimens that go along with it.
Furthermore, results indicate that by shrinking the prostate, finasteride, rather than causing more high-grade prostate tumors, was actually making the tumors easier to discover during biopsy. This study involved over 18,000 men over a period of 18 years. Aggressive tumors were found in 3.5% of men taking finasteride, versus 3% of men who were not, yet the survival rate in both groups was the same after 15 years.
Chief medical officer for the American Cancer Society, Dr. Otis Brawley, believes that the increased diagnosis of high-grade tumors in men taking finasteride is due to the drug’s ability to shrink the enlarged prostate. “You take Proscar for six months to a year and it halves the size of your prostate, but the cancer inside your prostate does not shrink. If I’m performing a biopsy on a smaller prostate, I’m more likely to hit that cancer than if I am sticking into a larger prostate.”
What the New Study Results Mean
The new study results could prompt calls for a fresh look at whether finasteride can be prescribed specifically for prostate cancer prevention. By preventing tens of thousands of cases each year, the drug could spare many men from going through prostate cancer treatment, which can have life-altering side effects.
Finasteride doesn’t affect survival rates, and so the drug’s real value may be in reducing the diagnosis of minor prostate cancers that in many cases should not be treated anyway, because these tumors tend to grow slowly enough that men are likely to die from some other cause before the cancer could become life-threatening.
Possible Implications for Prescribing Propecia
Doctors are allowed to prescribe finasteride “off-label,” but the earlier findings of increased high-grade tumors prompted some physicians to stop prescribing finasteride altogether. If the new study results cause the Food and Drug Administration to revisit labeling requirements and possibly allow prescription of finasteride for prevention of prostate cancer, it is more likely that doctors who haven’t been prescribing it will reconsider, and that insurers will cover the drug when it is prescribed for cancer prevention. Currently, insurers generally only cover finasteride when it is prescribed to treat urinary problems related to an enlarged prostate.
General Prostate Screening Guidelines
Prostate cancer is rare in men under age 50. The incidence rises rapidly, however, in the decades after. Prostate cancer is more common in African American men than in white men, and there is little consensus on the best way to treat localized prostate cancer. Men should discuss prostate screening with their physicians to make an informed decision on whether or when to begin screening based on family history and other health factors.
Men who are interested in taking Propecia to treat male pattern hair loss should be reassured by the recent results of the long-term study of men taking finasteride. eDrugstore.com dispenses both Propecia and generic finasteride for male pattern baldness, and is committed to patient safety and privacy, as well as the highest standards for customer service.
We specialize in providing our over 1,000,000 customers with relevant product and condition information created by our professional editorial staff which includes our team of medical writers, medical practitioners, and health educators. eDrugStore.com Staff on Facebook