Can finasteride help prevent prostate cancer?

Finasteride is a Food and Drug Administration (FDA) approved pill used to treat a noncancerous enlargement of the prostate that can block the flow of urine.

A 10-year study of more than 18,000 men was completed by the National Cancer Institute. The goal was to see whether low-dose finasteride cut the rate of prostate cancer in subjects. About half the guys in the study got finasteride (5 milligram daily dose); the other half got a placebo (sugar pill). At the end of the study, the results were clear: 18 percent of men in the finasteride group developed prostate cancer vs. 24 percent of men in the placebo group. That means the guys taking finasteride had an overall rate of prostate cancer 25 percent less than the guys on placebo.

Dr. Marc B. Garnick, MD
Hematologist & Oncologist

Although the Prostate Cancer Prevention Trial (PCPT) showed a 25 percent reduced risk of prostate cancer among men who took finasteride, doctors have not been prescribing the drug for prostate cancer prevention, a recent study found. The study surveyed 599 urologists and primary care providers within the Veterans Health Administration about their prescribing patterns.

Although the number of men taking finasteride increased during the six-year period, publication of the PCPT results had little impact. Among doctors who reported changing their prescribing habits, fewer than 2 percent said they were influenced by the PCPT. Also of note, 64 percent of urologists and 80 percent of primary care providers said they never prescribe finasteride to prevent prostate cancer. Asked why, more than half of urologists said they were concerned about inducing high-grade tumors, while about half of primary care providers didn't know the drug could be used for chemoprevention.

The majority of urologists and many of the primary care providers who did prescribe finasteride for disease prevention reserved it for patients at high risk for prostate cancer, although they were more likely to prescribe it for men with moderate to severe benign prostatic hyperplasia (BPH) than men with known risk factors for prostate cancer. So even when the doctors were aware of the benefits, they were reluctant to prescribe finasteride to otherwise healthy men because of the potential risks, the researchers concluded.

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