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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
5-α reductase inhibitors and prostate cancer prevention: where do we turn now?
Robert J Hamilton1, Stephen J Freedland
1Division of urology, Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada.
Abstract:
With the lifetime risk of being diagnosed with prostate cancer so great, an effective chemopreventive agent could have a profound impact on the lives of men. Despite decades of searching for such an agent, physicians still do not have an approved drug to offer their patients. In this article, we outline current strategies for preventing prostate cancer in general, with a focus on the 5-α-reductase inhibitors (5-ARIs) finasteride and dutasteride. We discuss the two landmark randomized, controlled trials of finasteride and dutasteride, highlighting the controversies stemming from the results, and address the issue of 5-ARI use, including reasons why providers may be hesitant to use these agents for chemoprevention. We further discuss the recent US Food and Drug Administration ruling against the proposed new indication for dutasteride and the change to the labeling of finasteride, both of which were intended to permit physicians to use the drugs for chemoprevention. Finally, we discuss future directions for 5-ARI research.
Insights
Effective prostate cancer chemoprevention remains elusive. 5-alpha-reductase inhibitors (5-ARIs) like finasteride and dutasteride show promise but face controversies and regulatory hurdles for widespread use.
Area of Science:
- Oncology
- Pharmacology
- Preventive Medicine
Background:
- Prostate cancer poses a significant lifetime risk to men, necessitating effective chemopreventive strategies.
- Despite extensive research, no approved chemopreventive drug is currently available for prostate cancer.
- 5-alpha-reductase inhibitors (5-ARIs), including finasteride and dutasteride, are explored for prostate cancer prevention.
Discussion:
- Landmark randomized controlled trials of finasteride and dutasteride have yielded controversial results regarding their efficacy and safety.
- Physician hesitancy in utilizing 5-ARIs for chemoprevention stems from these controversial findings and potential side effects.
- Recent US Food and Drug Administration (FDA) decisions have impacted the potential indications for dutasteride and finasteride labeling for chemoprevention.
Key Insights:
- The clinical utility of 5-ARIs for prostate cancer chemoprevention is debated due to trial outcomes and regulatory actions.
- Understanding the controversies and provider perspectives is crucial for advancing prostate cancer prevention strategies.
- Regulatory rulings on dutasteride and finasteride labeling highlight the complexities in approving agents for chemoprevention.
Outlook:
- Future research directions are essential to clarify the role of 5-ARIs in prostate cancer chemoprevention.
- Further investigation is needed to address safety concerns and optimize the use of 5-ARIs.
- Exploring novel chemopreventive agents and refining existing ones remains a priority in oncology research.
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