Propecia and Prostate Cancer - Survival and Side Effects

Balding drug Propecia can be used in prostate cancer prevention.
Balding drug Propecia can be used in prostate cancer prevention. Stephen Chernin/Getty Images

What do we know about Propecia and prostate cancer? Has research that seems to show a possible protective benefit for some men taking Propecia really changed what doctors recommend to men with a high risk of developing prostate cancer?

Research on Propecia and Prostate Cancer

Evidence has come forward that Propecia (finasteride) -- a drug used to treat male pattern baldness -- could possibly help in the prevention of prostate cancer in men with a high risk of developing the disease.

Other studies have also shown that Propecia (or similar drugs) may delay the onset of prostate cancer in some men.

It was long thought that Propecia or similar drugs might offer some protective benefits given how they work in the body. Propecia is one of a class of drugs that counteract the effects of testosterone in the body. Testosterone is known to be one of the major drivers of prostate cancer growth.

What is important to remember about these studies is that they are only preliminary. Additionally, some men who have taken Propecia or similar drugs in an attempt to prevent or delay prostate cancer have also encountered significant side effects.

What Are Some of the Most Important Potential Side Effects of Propecia?

Because Propecia counteracts the effects of testosterone in the body, significant sexual side effects can develop. In one study roughly 1/3 of men discontinued the use of Propecia for reasons other than cancer.

Additionally, studies have shown that the PSA level of men on Propecia may be recorded as falsely low, causing cancers to be missed.

Propecia and Prostate Cancer Incidence

Most importantly, some studies have shown that while men taking Propecia may have a slightly smaller chance of developing prostate cancer, those cancers that do develop tend to be of a higher grade and more aggressive on average.

Propecia and Prostate Cancer Survival

While the incidence of prostate cancer is decreased somewhat for men using Propecia, studies have yet to show that the medication has any effect on survival, either from prostate cancer or from overall causes of death. The reason may be that in studies to date there have been very few deaths, making this statistic difficult to evaluate, or it could be that while it decreases incidence it does not make a difference in survival. Another option may be that Propecia decreases the incidence of low-grade cancers, but does not have an effect on high-grade (more likely to be fatal) cancers.

Do Doctors Typically Recommend Propecia for Prostate Cancer Prevention?

Today, very few doctors recommend Propecia to the the vast majority of men with prostate cancer. This is primarily due to the sometimes significant side effects that can results, but it is also due to the possibility that men taking Propecia or similar drugs will develop more aggressive cancers (as some studies have suggested).

Overall, if Propecia is a drug that you are interested in taking in the hopes of prostate cancer prevention, talk to your doctor and be sure to review all of the pros and cons of the decision.

Sources:

Azzouni, F., and J. Mohler. Role of 5a-reductase inhibitors in prostate cancer prevention and treatment. Urology. 79(6):1197-20.

Hoque, A. et al. Effect of finasteride on serum androstenedione and risk of prostate cancer within the prostate cancer prevention trial: differential effect on high- and low-grade disease. Urology. 2015. 85(3):616-20.

Murtola, T. et al. Inflammation in benign prostate tissue and prostate cancer in the finasteride arm of the Prostate Cancer Prevention Trial. Cancer Epidemiology Biomarkers and Prevention. 2015 Dec 29. (Epub ahead of print).

National Cancer Institute. Prostate Cancer Prevention – for health professionals (PDQ). Updated 02/06/15.

Thompson, I. et al. The influence of finasteride on the development of prostate cancer. The New England Journal of Medicine. 2003. 349(3):215-34.

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