Update on Finasteride to Prevent Prostate Cancer Finasteride lowered the incidence of detected prostate cancer but did not improve survival. To determine whether finasteride (Proscar and generics) prevents prostate cancer, 19,000 men received finasteride or placebo for 7 years in the randomized Prostate Cancer Prevention Trial. The initial findings were published in 2003: Fewer prostate cancers overall — but more high-grade cancers — were detected in the finasteride group (NEJM JW Gen Med Jul 18 2003). Some authors speculated that the apparent increase in high-grade cancers was spurious — an artifact of finasteride-induced prostate shrinkage, which enabled easier detection of high-grade cancers in random biopsy samples (NEJM JW Gen Med Oct 11 2007). Now, the researchers offer additional posttrial follow-up data, focused on survival after randomization. Estimated 15-year survival rates were virtually identical in the finasteride and placebo groups. In addition, among men in whom prostate cancer was diagnosed, estimated survival was similar in the finasteride and placebo groups. Because cause-of-death information was unavailable for many men, prostate cancer–specific mortality was not assessed. COMMENT If the overall reduction in prostate cancer incidence had been clinically important, survival should have improved in the finasteride group. In contrast, if finasteride truly had induced more aggressive cancers, survival should have decreased in the finasteride group. In fact, neither of these outcomes occurred: Survival was the same in the finasteride and placebo groups. Although the absence of information on prostate cancer–specific mortality is a limitation, these findings argue against using finasteride for chemoprevention of prostate cancer. Allan S. Brett, MD reviewing Thompson IM et al. N Engl J Med 2013 Aug 15. CITATION(S): Thompson IM et al. Long-term survival of participants in the prostate cancer prevention trial. N Engl J Med 2013 Aug 15; 369:603. [PubMed® abstract] NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2013 Massachusetts Medical Society. All rights reserved.
Posted on: Fri, 06 Sep 2013 22:03:49 +0000
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