Should finasteride be used to prevent prostate cancer?

Area of Science:

• Oncology
• Public Health
• Pharmacology

Background:

• Prostate cancer is a major public health concern.
• Chemoprevention can decrease cancer mortality and reduce overtreatment.
• Adverse effects of radical treatment include erectile and urinary dysfunction.

Purpose of the Study:

• To evaluate the efficacy of finasteride in prostate cancer chemoprevention.
• To assess the impact of finasteride on prostate cancer incidence and grade.
• To inform clinical decision-making regarding prostate cancer prevention strategies.

Main Methods:

• A 7-year randomized, placebo-controlled trial (Prostate Cancer Prevention Trial).
• Inclusion of men over 55 years old.
• Prostate biopsy at study conclusion for all participants.

Main Results:

• A 25% reduction in overall prostate cancer prevalence with finasteride compared to placebo (6% absolute risk reduction).
• Higher-grade cancers were observed in the finasteride arm, attributed to trial design biases.
• Ongoing debate regarding the clinical significance of prevented cancers.

Conclusions:

• 5-alpha reductase inhibitors (5ARIs) offer chemoprevention benefits for men undergoing treatment for benign prostatic hyperplasia.
• Men at high risk for clinically significant prostate cancer should be informed about 5ARI risks and benefits.
• Further trials are needed to fully define the role of 5ARIs in prostate cancer chemoprevention.