Mixed results regarding finasteride for prostate cancer prevention

Image: PD 

1. Finasteride reduces the risk of developing prostate cancer overall, but increases risk for high-grade prostate cancer. 

2. Finasteride neither increased nor decreased overall survival or prostate cancer survival. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The Prostate Cancer Prevention Trial (PCPT), published in 2003, showed that finasteride reduces the risk of developing prostate cancer. However it also increases risk for developing high-grade disease. This raised concerns that the preventive benefits of finasteride in some men were negated by the induction of more aggressive cancers in others. Consequently, finasteride was not approved for prevention of prostate cancer.

Here, the authors report the results of a long-term follow-up study of men in the PCPT. They analyze mortality data to determine whether, in fact, finasteride treatment has a negative effect on long-term survival. They find that finasteride has no effect on long-term survival in either the general PCPT cohort or in men from the PCPT who were diagnosed with prostate cancer.

The finding that finasteride has neither a negative nor positive effect on survival is equivocal because, on one hand, the safety of finasteride is vindicated, while on the other, finasteride is ineffectual as a preventive measure. Nevertheless, the authors suggest that finasteride may find a niche in the fraught landscape of prostate cancer screening. Since it decreases the incidence of low-grade prostate cancer, finasteride could help reduce the high rates of overdiagnosis that plague PSA screening.

Click to read the study, published today in NEJM

Relevant Reading: The influence of finasteride on the development of prostate cancer

In-Depth [randomized controlled trial]: The PCPT trial randomized 18,882 men into a finasteride or placebo group. The majority of study participants were followed for 10 years. This study represents the results of a long-term follow-up study of the PCPT cohort focused on measuring survival in the PCPT cohort in general, and in the subset of men in the PCPT who were diagnosed with prostate cancer during the trial. The Social Security Death Index was used to identify deaths from any cause since the conclusion of the trial.

The 15-year survival rates were equivalent between the finasteride and placebo groups: 78% vs. 78.2%, adjusted hazard ratio 1.03 (95% CI, 0.98 to 1.09, P=0.26). The 10-year survival rates were also equivalent for men who had been diagnosed with prostate cancer during the trial: 79.3% with finasteride vs. 79.5% with placebo.

By Tomi Jun and Mitalee Patil

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