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Pharmacy Link

MEDICATION FOR BPH: FINASTERIDE AND PROSTATE CANCER

Can finasteride help prevent malignant growth in the prostate? In other words, can it stop prostate cancer from forming? The National Cancer Institute has launched a multimillion-dollar study to find this out. For seven years, this massive project will follow 18,000 men, aged 55 and older, who are otherwise healthy (men with any prostate ailment, benign or otherwise, are not eligible). All of-the men will take daily pills; half of them will get finasteride, the rest will get a placebo. All of the men will have regular physical exams, including a digital rectal exam and PSA test, during the study period. And, at the end of the study, all of the men will have a prostate biopsy. The study is double-blind—neither the men participating in the study nor the physicians treating them will know who’s getting the finasteride until it’s over.

Why do scientists think a BPH drug can have an effect on prostate cancer? One reason is that finasteride lowers a man’s levels of PSA, an enzyme made by the prostate used as an indicator for prostate cancer. Another assumption is tied to the fact that finasteride works by interrupting a hormonal process (it blocks an enzyme called 5-alpha-reductase, which changes the male hormone testosterone into a substance called DHT—the active form of male hormone within the prostate). Prostate cancer is intrinsically linked to hormonal activity. So maybe, some scientists speculate, by thwarting the prostate’s normal hormonal pattern, prostate cancer can be stopped before it ever has a chance to begin.

However, other scientists doubt that finasteride will have any effect in preventing prostate cancer. First, there’s no evidence that DHT is the hormone responsible for the growth of prostate cancer. In fact, the levels of 5-alpha reductase activity are actually lower in prostate cancer than in normal tissue. Also, there’s no supporting evidence from laboratory experiments to suggest that finasteride will work; in one animal tumor model, in fact, finasteride has no effect at all. And finally, finasteride’s effect in men who already have prostate cancer is marginal at best—which makes it unlikely that it will have any effect in preventing the disease.

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