According to a recent study, finasteride may be useful to lessen the risk of prostate cancer. The study comes as a follow up of an original trial, and has received extensive attention from the medical community in the US. Here we consider the implications of the findings.

In the original study, which was published in 2003, nearly 19 000 men above the age of 55 took part. All of the participants were deemed otherwise healthy, and blood tests and physical exams suggested that they had not had prostate cancer. The participants were split into two groups, with one receiving Finasteride and the other group receiving placebo treatment. The researchers then followed the participants after seven years and found that nearly a third less of the participants in the treatment group did not have prostate cancer compared with the control group. However, there was also some data to suggest that individuals who used Finasteride had more aggressive tumours relating to prostate cancer. Despite this information the researchers argued that research needed to establish whether Finasteride would reduce prostate cancer risk, or could be prescribed in the treatment of prostate cancer.

The most recent discussion from this team came in an editorial that was published in New England Journal of Medicine. In the article, the research team stated that they had been following the original participants for 18 years, and that the key findings indicated lack of differences between survival rates after being diagnosed with prostate cancer. This suggested that if Finasteride had led to the development of aggressive tumors, then the follow up would have indicated a higher death rate among individuals in the treatment group but this was not the case.  Based on this, the researchers stressed that there is a need to consider the use of Finasteride in cancer prevention.

It is worth mentioning that although Finasteride is an active ingredient in Propecia, which is used to treat hairloss, it is not currently clear what dosage would be required for the treatment to be considered suitable for prevention of prostate cancer.

We feel that the current study is convincing in many ways, perhaps mostly due to the extent of the follow up and the size of the sample. However, as the full details have not yet been published, we cannot be sure we would agree once this information becomes available. One aspect that appears particularly bothersome is the fact that it is not clear to what extent men adhered to Finasteride treatment, and what statistical analysis was used to back up the researchers’ conclusions.

Although the findings may turn out to be reliable, we still think there is a need for a discussion to consider under what circumstances it would be appropriate to prescribe this treatment on a precautionary basis. Therefore, until more information emerges, we remain undecided on the need for the treatment in this area. You can read more about this stidy here - http://www.cancer.gov/newscenter/qa/2008/PCPTQandA