Harvard Perspectives on Prostate Disease

Prevent prostate cancer? Maybe, maybe not.

A message from Editor in Chief Marc B. Garnick, M.D.

In February 2009, the American Society of Clinical Oncology and the American Urological Association issued guidelines recommending that healthy men who are screened regularly for prostate cancer and show no symptoms of the disease talk with their doctor about the benefits and risks of taking a 5-alpha-reductase inhibitor (finasteride is one such drug) to reduce the risk of the disease. They also suggest that men who take this type of drug for another condition, such as an enlarged prostate, talk to their doctor about maybe continuing to use it for the possible prevention of cancer.

The guidelines stem from several clinical trials in which men took a 5-alpha-reductase inhibitor, to lower the level of a hormone that can contribute to the growth of prostate cancer, for one to seven years. The largest was the Prostate Cancer Prevention Trial (PCPT), which pitted finasteride against a placebo. Unfortunately, the study's initial findings generated confusion. Data show that men who took finasteride were about 25% less likely to get prostate cancer compared with men taking a placebo, but a higher number of men taking the drug developed aggressive disease compared with men who received the placebo.

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