Prostate cancer prevention has been thought to be in our reach with the development of Proscar, a hormone blocking medication, over a decade ago. Preliminary results were encouraging that the medication worked as expected, but subsequent data was more confusing. The medication was shown to prevent unaggressive forms of of prostate cancer, but promoted a very small number of aggressive prostate cancers, resulting in concern that such an approach was not worthwhile. As much good as bad would come from it, and in fact, perhaps it was even dangerous. In particular, this scenario of aggressive prostate cancer development was discouraging to the exact people most interested in prevention….those with a strong family history of the disease.
Now, a recent study (NEJM ARTICLE) has clarified the data and reduced the concerns about the aggressive prostate cancer being promoted by the medication, so that we can use this medication with less concern. Despite this encouraging information, the data shows that the patients taking prostate, despite less ‘low grade’ prostate cancer, did not live any longer….it did not confer a ‘reduced mortality’ benefit as we had expected. The only benefit was that it reduced the need for unnecessary prostate testing, a worthwhile result, but not what we had hoped for.
So, what is the take home message here? Prostar (finasteride) is safe to use, it is beneficial in benign prostate disease (so called BPH), and it will reduce some prostate testing, but it will not add years to your life. Is that worthwhile……you be the judge.