An ounce of prevention ?

The PCPT trial randomized thousands of men over 55 years of age to take finasteride or not during a 7 year period. The main results of the trial are summarized in an excellent way at an NCI website. (I definitely recommend you click on this link and read it for yourself) The main conclusion of the study was a 25% decrease in the risk of developing prostate cancer. One key finding that is often not emphasized was that 15% of men in the study who were biopsied at the end – all of whom had PSA less than 3 and NO indication for biopsy other than being in the study had cancer. This (along with many other considerations) is why it is so difficult to deal with screening recommendations. 1 in 6 men have cancer over the age of 55 and may not need to ever know about it. The FDA, however, did not go along with recommending finasteride as a preventive due to the controversy regarding a potential increase in high grade prostate cancer and instead added a warning label to this class of drugs. A summary of this controversy is here (also you must read for yourself).

So what to do or recommend?? As with screening, it is a very individual decision. A new article this month reviewed the overall lack of long term side effects in the men who took finasteride for 7 years which is encouraging. On the other hand, it is well known that finasteride results in erectile dysfunction in up to 1/3 of the men who take it (even though their urinary obstructive symptoms may improve). Thus, a man who has to get up often at night, has trouble emptying his bladder, and is not particularly sexually active might make a different decision than a man who has no obstructive symptoms and is very sexually active. Similarly, although this has not been well enough studied, men who are at increased risk for prostate cancer because their father or brother developed the disease might choose to take the “ounce of prevention” in spite of any side effects. I think this is important to discuss with your male first degree relatives and feel free to pass this blog on to them, including the links of course. They can read my other blogs (or the thousands of opinions out there) about whether or not to participate in screening. My own blogs show up when you do a search at the website (not available if you are reading this only in email) for “screening”.

All of this is “individualized medicine” at the macro level, and for a current view on this, they can end up with this lovely editorial in the New England Journal of Medicine this week, appropriately entitled “There is More to Life Than Death“. If you read these blogs frequently, I hope you will visit EACH link I put in, especially if you want to go to the source, but for this particular blog, I think doing that kind of “homework” is critical for making your own decision or helping a family member do so.

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