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Docs Shying Away From Drug That May Halt Prostate Cancer

THURSDAY, Aug. 12 (HealthDay News) -- Even though a major study found that the drug finasteride could lower the risk of prostate cancer by 25%, it is still not being widely prescribed for that purpose, Veterans Administration researchers report.

Under the name Proscar, finasteride is commonly prescribed to treat the non-cancerous condition called benign prostatic hyperplasia, as well as known as enlarged prostate. Finasteride is as well as sold under the brand name Propecia, to help treat masculine pattern baldness.

In 2003, the Prostate Cancer Prevention Trial (PCPT), involving more than 18,000 patients, found that finasteride incision the incidence of prostate cancer by 25% -- the earliest drug to do so.

But a much-publicized follow-up analysis undercut that pleasant news when it suggested that the drug may actually boost the odds of particularly aggressive prostate tumors.

At the time, "there was a concern that [finasteride] may possess made worse the number of cases of more very bad prostate cancer," explained the lead researcher of the recent study, Dr. Linda Kinsinger, essential consultant for preventive medicine at the Veterans Health Administration National Center for Health Promotion as well as Disease Prevention in Durham, N.C.

Upon a re-analysis of the data, but, that uptick in risk for more aggressive tumors turned out to be false: finasteride did not raise the risk for an aggressive tumor, it simply helped make prostate screening more sensitive, so these tumors were spotted more readily.

But the reassuring results of that 2008 re-analysis may not possess trickled down to doctors as well as patients today, Kinsinger's team reports in the September issue of Cancer Epidemiology, Biomarkers & Prevention.

Instead, too many doctors remain wary of prescribing finasteride, so the numbers of prescriptions written to help halt prostate cancer hasn't budged for years.

That's unfortunate, Kinsinger said, because "there does seem to be a benefit as well as it could be more widely used."

In the study, her team surveyed 325 urologists as well as 1,200 primary care doctors on their prescribing practices.

Among the doctors surveyed, 57% of urologists as well as 40% of primary care physicians said they prescribed finasteride more often, but only 2% said the PCPT trial results had influenced their decision.

Moreover, 64% of urologists as well as 80% of primary care physicians said they never prescribed finasteride with the aim of helping to halt prostate cancer.

Asked why, 55% said they were worried about the risk of the drug causing high-grade tumors, while 52% said they simply had no idea that finasteride could be used to halt prostate cancer.

The study was funded by the VA National Center for Health Promotion as well as Disease Prevention as well as the U.S. Department of Defense - Prostate Cancer Research Program.

Although the doctors in the survey all came from the VA health examination system, Kinsinger said these results most likely mirror what is happening throughout the United States.

Besides doctors being poorly informed about finasteride, patients' psychology probably plays a role as well, Kinsinger said. "As a wholesome person, why should I pay to take a drug that has some chance of causing me side effects to halt something that I may or may not get down the road?" she said. "I think that's a tough sell."

Another problem with the drug is who would benefit from using it, Kinsinger said. Men most likely to benefit from finasteride are those at highest risk from prostate cancer, such as men with a family history of the disease, she explained.

"But we are not very pleasant at narrowing the universe of men down to the subset of those who are actually at higher risk of developing prostate cancer," Kinsinger said. "If we could develop a means of identifying people who are truly at the highest risk for developing prostate cancer that would ideally be the target group, but we don't really know who those people are yet."

Prostate cancer expert, Dr. Anthony D'Amico, essential of radiation oncology at Brigham as well as Women's Hospital in Boston, agreed that the fear of adverse consequences of finasteride has made doctors reluctant to write prescription it.

"The bottom line is that despite all the well-designed as well as well-thought-out studies to explain why high-grade prostate cancer was increased, while low-grade prostate cancer diagnoses decreased with finasteride take in the PCPT, physicians remain hesitant to write prescription finasteride as a preventive agent," he said. "And so the observation in the VA system in the current study supports the sentiment I possess heard when traveling around the country as well as teaching on this topic."

So the path forward may be difficult, he said.

"The way it's thought of is 'If I take this drug I am going to halt a prostate cancer that may or may not need treatment. I am going to increase my risk, to a very tiny degree, of a cancer that may not be curable,'" he said. "And that's how people read it."

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