- © 2008 Canadian Medical Association
In their otherwise informative commentary on therapeutic advances in the treatment of benign prostatic hyperplasia, Michael Jewett and Laurence Klotz conclude that finasteride should be used routinely in men with lower urinary tract symptoms, pointing out that finasteride reduced the risk of prostate cancer by 25% in the Prostate Cancer Prevention Trial.1 However, the results of this trial were not really that unequivocal.2
The prevalence of prostate cancer in this trial was indeed significantly lower in the finasteride group than in the placebo group. Among men with a diagnosis of prostate cancer, however, high-grade prostate cancer occurred significantly more often in the finasteride group than in the placebo group (37.0% v. 22.2%). When one looks at the entire study population included in the trial's final analysis, the rate of high-grade prostate cancer was also higher in the finasteride group than in the placebo group (6.4% v. 5.1%).
The commentary that accompanied the trial report advises caution.3 The trial results have also been disturbing enough to raise concerns about the prescription of finasteride for baldness in young men.4 To my knowledge there have not been any new studies to dispel these concerns. Thus, I do not think finasteride can be recommended unequivocally.
Footnotes
-
Competing interests: None declared.
REFERENCES
- 1.
- 2.
- 3.
- 4.