To Proscar or Not to Proscar

So, I just came back from MD Anderson, and I am waiting for MRI results.

Without getting in numbers and details, this is my problem. I really hope you guys can help me out.

My urologist, Dr, ward, from MD Anderson prescribed Proscar and instructed me to return in a year for another MRI and psa. This is assuming the MRI I just took is clear. In the in between time, take the Proscar for a year but no PSA tests and no biopsies. Just a check up in a year.

My urologist in my hometown, Dr, Kella, disagrees with the Proscar. He labels it hormonal therapy and controversial.

I decided to not starting taking it until the MRI results come back. If it catches some high grade cancer then it is a moot point. But, if the MRI comes clean, I am not sure who to follow... My MD Anderson urologist or my local urologist.

What are some of your experiences with Proscar? I've read conflicting data online and I'm not sure what to think.

Thanks for your input!

You went to MD Anderson to get some of the best advice around, and you're questioning it on the advice of your local Uro? Fair enough - I'm a big believer in asking questions - but here's what you ought to be asking both of them - what is the evidence for your recommendation?

My guess is that your doctor at MD Anderson will show you something like the following study that showed that men on Active Surveillance taking Avodart (similar to Proscar) had an increased time until PSA progression and decreased risk of finding any cancer on f/u biopsy:

Effect of dutasteride on prostate cancer progression and cancer diagnosis on rebiopsy in the REDEEM active surveillance study.

Or maybe the following study among men on Active Surveillance who had very low risk PC and BPH and took either Proscar or Avodart. In up to 3 years of follow up, over half of them showed no sign of cancer on their repeat biopsies:
Active surveillance of very-low-risk prostate cancer in the setting of active treatment of benign prostatic hyperplasia with 5α-reductase inhibitors.

Your local doctor is right that Proscar is a kind of hormone therapy - it prevents testosterone from being converted into the more potent androgen DHT. It has some negative sexual side effects in about 20% of men. It may also prevent or reverse male pattern baldness. What is the nature of your local doctor's objection?

- Allen

I have considered taking finasteride or dutasteride to reduce my risk of prostate cancer. I have not been diagnosed with prostate cancer, but my father died of it and I have had a psa that is higher than typical for my age. I have discussed this issue with several of the leading prostate cancer experts in the country, including both researchers and practicing urologic oncologists, and I have read many articles on the subject. Sadly, there is no consensus. I have had very well respected doctors, with world-wide reputations, tell me not to take it, and others, equally well respected, say they would "seriously consider taking it" (and giving me a prescription). The FDA recommended against finasteride for chemoprevention. The Canadian Consensus Report was more open to it. Tough call. In the end, after all the asking doctors and researchers, and reading, I'm on my own.... (I have decided not to take it -- but of course a reasonable person could disagree with that decision).

I suppose using 5-ARIs as part of an AS protocol is a different issue than using it for chemoprevention. But, based on my own experience, it does not surprise me that you are getting conflicting advice...

Fairwind, thanks for clarifying that English Teacher had a negative biopsy. He didn't have a signature, and I didn't go back to his previous posts. I thought he was on Active Surveillance with MRI checks for progression. My bad.

English Teacher, there is formidable evidence that Proscar/finasteride or Avodart/dutasteride (a class of drugs called 5ARis) prevents low grade prostate cancer. The most recent - 18 year - update of the Prostate Cancer Prevention Trial (PCPT) - found that Proscar reduced the risk of prostate cancer by 30% vs placebo. There was no difference in the risk of death from PC, which certainly would have been the case if there were any safety concerns.

Long-Term Survival of Participants in the Prostate Cancer Prevention Trial

A recent meta-analysis of research studies on Avodart found similarly that it reduced incidence of prostate cancer by 34%, and there was no increased incidence of higher grade cancers.

The effect of dutasteride on the detection of prostate cancer: A set of meta-analyses

If you have BPH, your doctor will most likely suggest you take it anyway. It has a potential of preventing PC, and it makes PSA a more accurate tool for tracking any cancer.

- Allen

Not to many men with diagnosed PC, even a low-grade Gleason 6 are put on TRT...Is the Proscar supposed to keep your cancer in check while you enjoy high testosterone levels? That would be a rather unique approach to PC treatment..