Prevention of prostate cancer with finasteride: US/European perspective.
OBJECTIVE
Prostate cancer is the most common male cancer, affecting one man in six. Prevention of this disease, even in a subset of patients would have a significant impact on public health. The results of the National Cancer Institute-sponsored Prostate Cancer Prevention Trial demonstrate that finasteride causes a substantial risk reduction across all known risk groups. We herein amplify on the results of this trial to assist patients and physicians in reaching individualized decisions.


METHODS
The results of the Prostate Cancer Prevention Trial were reviewed.


RESULTS
The PCPT demonstrated a 24.8% reduction in prostate cancer risk with the administration of finasteride. High-grade cancers were noted in 6.4% of finasteride patients compared to 5.1% of men receiving placebo. The increase in high-grade tumors was seen within one year of finasteride exposure and did not increase over time. This observation, combined with previous evidence demonstrating an alteration in cytologic and architectural features of prostate cancer with hormonal therapy suggests that the differences in high-grade disease may be an artifact and that application of Gleason grading to these tumors may not be appropriate.


CONCLUSIONS
Men should be presented the benefits and risks of taking finasteride and be assisted in integrating their sexual and urinary symptoms into their decision-making process. Blanket statements for or against the use of this medication ignore patient preferences and differential risk-benefit profiles from finasteride.
Thompson
Ian M
IM
University of Texas Health Science Center, Division of Urology, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. thompsoni@uthscsa.edu
Klein
Eric A
EA
Lippman
Scott M
SM
Coltman
Charles A
CA
Djavan
Bob
B
D000368:Aged; D001291:Attitude of Health Personnel; D001707:Biopsy, Needle; D018849:Controlled Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005060:Europe; D018120:Finasteride / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States
D018120:Finasteride; D017430:Prostate-Specific Antigen