Will Finasteride Prevent Prostate Cancer?
Big headlines announced the results of a new study showing that finasteride (Proscar) reduces the risk of prostate cancer. As a nationally recognized expert on medication side effects and also on prostate cancer, I have analyzed thousands of medical studies. This one, “Long-Term Survival of Participants in the Prostate Cancer Prevention Trial,” published in the New England Journal of Medicine on August 15, 2013, wins a prize as one of the most misleading and alarming studies I’ve ever seen.
The study was big—18,880 men over 18 years, costing $73 million. Back in 2003, when the first phase of the study was published, I disliked it. I wasn’t alone. Dr. Peter Scardino, one of the most prominent urologists in the US and chairman of the department of urology at Memorial Sloan-Kettering Cancer Center in NYC, wrote in an accompanying editorial: “Should finasteride now be recommended to men in order to lower their risk of prostate cancer? Several disturbing findings in the report argue that it should not.” What did he mean?
The Drug’s Side Effects Are Devastating—and Unnecessary
Think of it this way. If 10 million men take finasteride, it will reduce their risk of prostate cancer by 38 percent. Sounds good, but at what cost? I am not talking about money, but side effects. You should know that finasteride blocks the conversion of testosterone to its more active derivative, dihydrotestosterone. Knowing this, it should come as no surprise that the drug can cause: reduced libido (10 percent), abnormal ejaculation (7.2 percent), impotence (18.5 percent), breast swelling (which can be painful; 2.2 percent), abnormal sexual functioning (2.5 percent). These numbers are from the manufacturer of finasteride and the FDA.
And remember, prostate cancer strikes 16 percent of men, which is a big number, but it never strikes the other 84 percent. Thus, of the 10 million men taking the finasteride, 8.4 million would never have gotten prostate cancer anyway, but many will still get the side effects. Still interested?
The Drug Lowers Risk for the Least Dangerous Type of Cancer
The second reason finasteride use should is cautioned is that it only lowers your risk of the low-grade forms of prostate cancer. These are the types that rarely harm. Unless, of course, with today’s backward methods, your doctor rushes you to biopsy, then surgery or radiation. In his book, Invasion of the Prostate Snatchers, prostate cancer specialist Dr. Mark Scholz states that of the 100,000 men who receive radical surgery or radiation for prostate cancer each year, only 15,000 actually need it.
The Drug Increases the Risk of Aggressive Cancers
Third, the finasteride study clearly demonstrates that the drug increases the risk of aggressive, life-threatening prostate cancers. These are the cancers you want to avoid, because they almost always require radical prostatectomy or intensive radiation therapy, the treatments that frequently cause life-long, sexual dysfunctions and/or bladder control problems. Worse, the article completely skirts this issue. The authors make a big deal of the fact that although the rate of aggressive cancers was increased, the rate of death (so far) was not — yet nowhere in the article do the authors describe the radical, injurious treatments these men will require.
In an August 14 NPR interview, Dr. Ian Thompson, the chief of the study, stated, “Even if there is a higher risk of high-grade cancer, it doesn’t appear to have an impact on how long a man lives, and that’s reassuring.” Not reassuring is his dodging the issue of the impact on quality of life from the radical treatments these men will need.
There Are Better, Newer, Safer Ways to Deal with Prostate Cancer
Yes, overtreatment is rampant. But thanks to doctors like Scardino and Scholz, this problem is slowly being eliminated. I know this firsthand. Diagnosed with prostate cancer in 2011, I consulted four top-flight urologists. Without doubt, each of them told me, I would need surgery or radiation. I was on the surgery schedule when, from a support group, I learned about the new MRIs that, for the first time, can show us the size and location of the man’s prostate cancer. My cancer was low-risk, solitary, and well contained. I took myself off the surgery schedule and have been doing fine on active surveillance with routine follow-up testing for nearly two years.
The dynamic, contrast-enhanced DCE-MRI is a game changer and available today at a dozen medical centers across the country. It is a big part of the renaissance of prostate cancer care that is just now beginning. It will be routine everywhere by 2020. In comparison, reducing low-grade prostate cancers with finasteride is backward, not forward thinking.
Early Detection Is the Key to a Cure
To me, this article is emblematic of the backward thinking of the medical profession regarding prostate cancer today. As I have explained in my book, Prostate Cancer Breakthroughs, abandoning PSA testing is abandoning our only reliable, proven, easily obtained method for diagnosing prostate cancer early. Early detection is the key to cure. Without PSA testing, annual prostate cancer deaths will increase from around 30,000 to 55,000. And now, the idea of recommending widespread use of finasteride to prevent some low-risk prostate cancers while increasing high-risk cancers is, to me, ridiculous.
The wave of the future is with PSA testing, DCE-MRI, and MRI-guided biopsy. These technologies and others will finally allow accurate diagnosing and end overtreatment. Only the men with severe prostate cancer will get radical treatment. Men with milder forms will be able to choose among several focal therapies (like a lumpectomy) or active surveillance. Maybe someday we will have a drug that prevents prostate cancers without impacting men’s sexuality or causing more aggressive cancers, but that drug is certainly not finasteride.